MEDICARE: MR. DONALD GEORGE BERTI MFT

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	106H00000X	Marriage & Family Therapist	MFT15116	CA

General Provider Information

NPI Number	:	1235322942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD GEORGE BERTI MFT

Provider Business Mailing Address
First Line	:	4990 SPEAK LN
Second Line	:	SUITE 100
City	:	SAN JOSE
State	:	CA
Zip	:	95118-4004
Country	:	US
Telephone Number	:	408-266-7826
Fax Number	:

Provider Business Practice Location Address
First Line	:	4990 SPEAK LN
Second Line	:	SUITE 100
City	:	SAN JOSE
State	:	CA
Zip	:	95118-4004
Country	:	US
Telephone Number	:	408-266-7826
Fax Number	:

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

Provider Enumeration Date	:	08/26/2007
Last Update Date	:	08/26/2007

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