Healthcare Provider Details

I. General information

NPI: 1063348266
Provider Name (Legal Business Name): KRISTINE MAE BARTOLOME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINE BARTOLOME

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E WARM SPRINGS RD STE 104
LAS VEGAS NV
89119-4230
US

IV. Provider business mailing address

PO BOX 230032
LAS VEGAS NV
89105-0032
US

V. Phone/Fax

Practice location:
  • Phone: 702-234-9657
  • Fax:
Mailing address:
  • Phone: 702-234-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: