Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 17146 | CA |
NPI | 1013192889 |
---|---|
Provider Name | Mr. Daniel Peter Bertheau |
First Address | San Francisco, CA 94103-2302 |
Second Address | San Francisco, CA 94103-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2007 |
Last Update Date | 29/12/2007 |