Healthcare Provider Details

I. General information

NPI: 1629137898
Provider Name (Legal Business Name): CHRISTINA R BARTLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 MAGNOLIA AVE
RIVERSIDE CA
92503-3609
US

IV. Provider business mailing address

9707 MAGNOLIA AVE
RIVERSIDE CA
92503-3609
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-7356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS18105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: