Roger Victor Bertoldi, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

A40519 Issued in CA

Practice address

300 UCLA Medical PLZ Ste B200
Los Angeles, CA 90095-4008

Phone

(310) 794-1195

Fax

(310) 794-7491

NPI assigned

Jul 13, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579046400000",
    "number": "1164447082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 UCLA MEDICAL PLZ STE B200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900954008",
            "telephone_number": "310-794-1195",
            "fax_number": "310-794-7491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTOLDI",
        "first_name": "ROGER",
        "middle_name": "VICTOR",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A40519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PPIN #",
            "identifier": "00A405190",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Barry Berson, DDS
• Bert J Thomas, MD
• Berta P Choy
• Rebecca C Bertin, M.D.
• Yun Ji Bertken, MD
• Michael Lewis Bertolucci, PH.D.
• Dylan Gregory Bertoni, MD
• Bertram B. Amiri DDS Inc.
• Landon Bertram
• Bertrand a. Marcano, MD Inc

• Neurology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.