Provider Demographics
NPI:1144625948
Name:BERTRAMS, DANIEL (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BERTRAMS
Suffix:
Gender:M
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N ROBERTSON BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2145
Mailing Address - Country:US
Mailing Address - Phone:424-542-8881
Mailing Address - Fax:
Practice Address - Street 1:150 N ROBERTSON BLVD STE 250
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2145
Practice Address - Country:US
Practice Address - Phone:424-542-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05093363AM0700X
CA55534363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical