Healthcare Provider Details

I. General information

NPI: 1184620411
Provider Name (Legal Business Name): JAMES ALVIN BARTLEY MD, PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 14TH ST SUITE # 310
RIVERSIDE CA
92501-4083
US

IV. Provider business mailing address

3701 WILSHIRE BLVD STE 600
LOS ANGELES CA
90010-2814
US

V. Phone/Fax

Practice location:
  • Phone: 909-633-6578
  • Fax: 909-533-2342
Mailing address:
  • Phone: 323-361-3550
  • Fax: 323-361-8052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG31441
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberG31441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: