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General NPI Number Information
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NPI Number | 1184025553
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Entity Type | Organization
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Legal Business Name | MARIO SAN BARTOLOME, MD, MBA, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 1760 TERMINO AVE SUITE 223
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City | LONG BEACH
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State | CA
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Zip | 90804-2105
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Country | US
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Telephone | 562-394-2469
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 N LAKEWOOD BLVD SUITE D704
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City | LONG BEACH
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State | CA
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Zip | 90815-2552
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIO SAN BARTOLOME
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Credential | MD
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Telephone | 562-394-2469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A89818
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License Number State | CA
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