Healthcare Provider Details

I. General information

NPI: 1932438488
Provider Name (Legal Business Name): RHEX BARTOLOME
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535 SHERMAN CIR
VAN NUYS CA
91405
US

IV. Provider business mailing address

14535 SHERMAN CIR
VAN NUYS CA
91405-3087
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4930
  • Fax: 844-236-9260
Mailing address:
  • Phone: 818-901-4930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number61573
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number97687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: