Healthcare Provider Details

I. General information

NPI: 1609822477
Provider Name (Legal Business Name): ROBERT BERTRAND BERTRANDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BERTRAND ROBERT BERTRANDO JR. MD

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E HASKELL ST
WINNEMUCCA NV
89445-3247
US

IV. Provider business mailing address

12625 ROSEVIEW LN
RENO NV
89511-8641
US

V. Phone/Fax

Practice location:
  • Phone: 775-623-5222
  • Fax:
Mailing address:
  • Phone: 775-851-1266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5202
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: