1073071569 NPI number — MR. JASON ALEXANDER BERTEMATTI PA-C

Table of content: MR. JASON ALEXANDER BERTEMATTI PA-C (NPI 1073071569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073071569 NPI number — MR. JASON ALEXANDER BERTEMATTI PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERTEMATTI
Provider First Name:
JASON
Provider Middle Name:
ALEXANDER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073071569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8975 SW 86TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33173-4540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-439-9411
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7600 SW 87TH AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33173-3635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-275-6770
Provider Business Practice Location Address Fax Number:
305-275-6440
Provider Enumeration Date:
03/04/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  9112014 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com