Healthcare Provider Details

I. General information

NPI: 1740818350
Provider Name (Legal Business Name): BENJAMIN BERTHET DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 DAVIS BLVD STE 308
TAMPA FL
33606-3438
US

IV. Provider business mailing address

100 WILSON RD STE 100
MONTEREY CA
93940-7885
US

V. Phone/Fax

Practice location:
  • Phone: 813-250-2529
  • Fax:
Mailing address:
  • Phone: 831-242-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A23241
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A23241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: