Active NPI
Raymond Bertolotti, DDS
- Dentist
- San Leandro, CA
National Provider Identifier
1568039659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- CA27505
- Practice address
- 345 Estudillo Ave
San Leandro, CA 94577-4702 - Phone
- (510) 483-2164
- NPI assigned
- Jun 7, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | CA27505 | CA | Primary |
Addresses
Primary practice location
345 Estudillo Ave
San Leandro, CA 94577-4702
Mailing address
188 Beechwood Dr
Oakland, CA 94618-2014
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CA27505 | Other | CA | CA27505 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CA27505 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623024000000",
"number": "1568039659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "188 BEECHWOOD DR",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946182014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 ESTUDILLO AVE",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945774702",
"telephone_number": "510-483-2164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTOLOTTI",
"first_name": "RAYMOND",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-06-07",
"last_updated": "2021-06-07",
"certification_date": "2021-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "CA27505",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA27505",
"identifier": "CA27505",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Leandro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.