Provider Demographics
NPI:1679892939
Name:BERTOLINI, LINDA MARIE
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:BERTOLINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N STAR DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-7921
Mailing Address - Country:US
Mailing Address - Phone:707-509-9519
Mailing Address - Fax:
Practice Address - Street 1:1901 CLEVELAND AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4298
Practice Address - Country:US
Practice Address - Phone:707-576-0818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT14228167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician