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NPI Code Detail

MEDICARE: ANDREW E BERTAGNOLLI PH D

MEDICARE: ANDREW E BERTAGNOLLI PH D
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
1103T00000XPsychologist11380MA
2103T00000XPsychologistPSY15734CA
3103T00000XPsychologist1638HI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00360060OTHERCARAILROAD MEDICARE

General Provider Information

NPI Number : 1578683926
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW E BERTAGNOLLI PH D
Provider Business Mailing Address
First Line : 1 EMBARCADERO CTR STE 1900
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94111-3723
Country : US
Telephone Number : 415-658-6791
Fax Number :
Provider Business Practice Location Address
First Line : 7740 EL CAMINO REAL STE F
Second Line :
City : CARLSBAD
State : CA
Zip : 92009-8514
Country : US
Telephone Number : 888-663-6331
Fax Number : 415-252-7176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2007
Last Update Date : 12/19/2025

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Directions to “ ANDREW E BERTAGNOLLI PH D” Practice Location

Language Start Address Practice Location
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