Individual provider · NPI-1
Dr. Mario Fernando San Bartolome Jr., MD
Preventive Medicine, Addiction Medicine · Westminster, CA
NPI number1154420024
StatusActive
Last updated in NPPESAug 8, 2019
Details
- NPI
- 1154420024
- Entity type
- Individual (NPI-1)
- Name
- Dr. Mario Fernando San Bartolome Jr.
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 21, 2006
- Last updated
- Aug 8, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2083A0300X | Preventive Medicine, Addiction Medicine | A89818 | CA | Yes |
| 207QA0000X | Family Medicine, Adolescent Medicine | A89818 | CA | |
| 207QA0505X | Family Medicine, Adult Medicine | A89818 | CA | |
| 174400000X | Specialist | A89818 | CA |
Practice location
5405 Garden Grove Blvd Ste 102Westminster, CA 92683-1887
Phone 714-598-3707 · Fax 714-422-0260
Mailing address
5405 Garden Grove Blvd Ste 102Westminster, CA 92683-1887
Phone 714-598-3707 · Fax 714-422-0260
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