Individual
BRAD DWAYNE BERTRAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1600 MARKET ST, SAN FRANCISCO, CA 94102-5910
(415) 746-1812
(415) 829-2326
Mailing address
3400 DATA DR, ATTN CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN104830
LA
363LF0000X
Family Nurse Practitioner
Primary
95011767
CA
363LF0000X
Family Nurse Practitioner
AP07021
LA
Other
Enumeration date
11/13/2013
Last updated
03/09/2020
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