Provider Demographics
NPI:1386734150
Name:VANDEVILLE, BERTRAND ANDRE (DO)
Entity type:Individual
Prefix:
First Name:BERTRAND
Middle Name:ANDRE
Last Name:VANDEVILLE
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 BON AIR CTR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-3000
Mailing Address - Country:US
Mailing Address - Phone:415-578-3095
Mailing Address - Fax:415-291-0489
Practice Address - Street 1:350 BON AIR CTR
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-3000
Practice Address - Country:US
Practice Address - Phone:415-578-3095
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH79503Medicare UPIN