Healthcare Provider Details

I. General information

NPI: 1669561858
Provider Name (Legal Business Name): CONNIE P BARTLETT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE 700
ORANGE CA
92868-4213
US

IV. Provider business mailing address

1201 W LA VETA AVE 700
ORANGE CA
92868-4213
US

V. Phone/Fax

Practice location:
  • Phone: 714-288-3230
  • Fax: 714-744-5294
Mailing address:
  • Phone: 714-288-3230
  • Fax: 714-744-5294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A6599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: