MEDICARE: DR. GEMI BERTRAN DR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	133NN1002X	Nutrition Education Nutritionist	XLUFNSQT11K9	CA
3	133NN1002X	Nutrition Education Nutritionist
4	101YS0200X	School Counselor
5	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83-3565189	OTHER	CA	I DON'T HAVE AN INSURER NUMBER

General Provider Information

NPI Number	:	1023636859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEMI BERTRAN DR.

Provider Business Mailing Address
First Line	:	1244 MILL ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2815
Country	:	US
Telephone Number	:	805-215-4385
Fax Number	:

Provider Business Practice Location Address
First Line	:	1244 MILL ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2815
Country	:	US
Telephone Number	:	805-215-4385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	11/10/2025

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Directions to “ DR. GEMI BERTRAN DR.” Practice Location

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