Healthcare Provider Details

I. General information

NPI: 1467497958
Provider Name (Legal Business Name): BARTHOLOMEW C PALENCHAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 SAN BERNARDINO RD
UPLAND CA
91786-4920
US

IV. Provider business mailing address

9320 BASELINE RD SUITE C
RANCHO CUCAMONGA CA
91701-5829
US

V. Phone/Fax

Practice location:
  • Phone: 909-466-4231
  • Fax: 909-456-1255
Mailing address:
  • Phone: 909-466-4231
  • Fax: 909-456-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG30732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: