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General NPI Number Information
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NPI Number | 1578683926
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Entity Type | Individual
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Provider Name | ANDREW E BERTAGNOLLI PH D
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 7740 EL CAMINO REAL STE F
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City | CARLSBAD
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State | CA
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Zip | 92009-8514
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Country | US
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Telephone | 888-663-6331
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Fax | 415-252-7176
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Provider Business Mailing Address
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Address Line | 1 EMBARCADERO CTR STE 1900
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-3723
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Country | US
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Telephone | 415-658-6791
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 11380
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY15734
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1638
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License Number State | HI
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