Healthcare Provider Details

I. General information

NPI: 1134055072
Provider Name (Legal Business Name): TANIA BARTHELEMY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W ALLEN AVE STE 6
SAN DIMAS CA
91773-1477
US

IV. Provider business mailing address

9200 MILLIKEN AVE APT 6206
RANCHO CUCAMONGA CA
91730-8509
US

V. Phone/Fax

Practice location:
  • Phone: 774-297-1280
  • Fax:
Mailing address:
  • Phone: 774-297-1280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number84571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: