Basic Information
| Provider Information | |||||||||
| NPI: | 1780878967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERTA | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | COLLINS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 DE ANZA BLVD | ||||||||
| Address2: | STE 112 | ||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944023989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503391000 | ||||||||
| FaxNumber: | 6502311286 | ||||||||
| Practice Location | |||||||||
| Address1: | 2175 ROSALINE AVE | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960012509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302256000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2007 | ||||||||
| LastUpdateDate: | 12/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | A91971 | CA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | ME107711 | FL | N | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.