Healthcare Provider Details

I. General information

NPI: 1164030268
Provider Name (Legal Business Name): CHERIDAN BARTKOSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 S MAIN AVE
FALLBROOK CA
92028-3325
US

IV. Provider business mailing address

323 FALABELLA LN
FALLBROOK CA
92028-5708
US

V. Phone/Fax

Practice location:
  • Phone: 760-645-6570
  • Fax:
Mailing address:
  • Phone: 714-423-6934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA8536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: