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General NPI Number Information
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NPI Number | 1235501636
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Entity Type | Organization
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Legal Business Name | USC CARUSO DEPARTMENT, OTOLARYNGOLOGY-HEAD AND NECK SURGERY
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Dates
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Enumeration Date | 10/24/2015
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Last Update Date | 10/24/2015
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Provider Practice Location Address
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Address Line | 1983 MARENGO ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-1370
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Country | US
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Telephone | 323-409-5070
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Fax |
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Provider Business Mailing Address
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Address Line | 1540 ALCAZAR ST SUITE 204M
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City | LOS ANGELES
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State | CA
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Zip | 90089-0080
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RESIDENT PHYSICIAN
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Name | CAITLIN BERTELSEN
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Credential | M.D.
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Telephone | 323-226-7315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | A138856
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License Number State | CA
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