Provider Demographics
NPI:1447324405
Name:BERTINO, TERESA RENEE (NP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:RENEE
Last Name:BERTINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13938 CARRIAGE RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-3836
Mailing Address - Country:US
Mailing Address - Phone:858-391-1666
Mailing Address - Fax:
Practice Address - Street 1:5500 CAMPANILE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92182-4701
Practice Address - Country:US
Practice Address - Phone:619-594-6681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14992363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health