MEDICARE: MARIA J BERTORELLO DPM

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	213E00000X	Podiatrist	1164	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639157035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA J BERTORELLO DPM

Provider Business Mailing Address
First Line	:	PO BOX 550227
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77255-0227
Country	:	US
Telephone Number	:	713-468-3668
Fax Number	:	713-468-3676

Provider Business Practice Location Address
First Line	:	12727 KIMBERLEY LN
Second Line	:	SUITE 102
City	:	HOUSTON
State	:	TX
Zip	:	77024-4047
Country	:	US
Telephone Number	:	713-468-3668
Fax Number	:	713-468-3676

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	12/23/2010

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