Provider Demographics
NPI:1700096385
Name:HOOKS, BERTINA MARIE (MD)
Entity type:Individual
Prefix:
First Name:BERTINA
Middle Name:MARIE
Last Name:HOOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12446 WEST AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2530
Mailing Address - Country:US
Mailing Address - Phone:210-525-1668
Mailing Address - Fax:210-525-1669
Practice Address - Street 1:1 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-781-1927
Practice Address - Fax:916-781-1787
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066356207R00000X
WAMD61472474207R00000X
CAA133270207R00000X
TXS9706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA133270OtherSTATE MEDICAL LICENSE