Healthcare Provider Details

I. General information

NPI: 1386680163
Provider Name (Legal Business Name): WILLIAM LEROY BARTLETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E 17TH ST W-131
SANTA ANA CA
92701-2201
US

IV. Provider business mailing address

1125 E 17TH ST W-131
SANTA ANA CA
92701-2201
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-1705
  • Fax: 714-972-1732
Mailing address:
  • Phone: 714-972-1705
  • Fax: 714-972-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA21264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: