Healthcare Provider Details

I. General information

NPI: 1497971220
Provider Name (Legal Business Name): MARTHA E. BARTZEN R.N., PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 E MADISON AVE
EL CAJON CA
92020-3819
US

IV. Provider business mailing address

9327 GOLONDRINA DR
LA MESA CA
91941-5647
US

V. Phone/Fax

Practice location:
  • Phone: 619-441-6503
  • Fax:
Mailing address:
  • Phone: 619-463-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number384007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: