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General NPI Number Information
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NPI Number | 1073791992
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Entity Type | Individual
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Provider Name | JACQUELINE SIEGEL-BARTELT M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 124 W THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85013-4405
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Country | US
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Telephone | 602-406-5477
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Fax | 602-798-9988
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Provider Business Mailing Address
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Address Line | 634 PIER AVE
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City | SANTA MONICA
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State | CA
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Zip | 90405-4557
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Country | US
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Telephone | 310-383-5498
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | 37842
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 37842
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License Number State | AZ
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