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General NPI Number Information
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NPI Number | 1932857489
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Entity Type | Individual
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Provider Name | MR. ALLAN CORNES BARTOLOME
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Gender | Male
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 147 LAKE SHORE DRIVE
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4055
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Country | US
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Telephone | 760-610-1343
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Fax |
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Provider Business Mailing Address
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Address Line | 70210 HIGHWAY 111 SPACE 42A
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4055
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Country | US
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Telephone | 760-980-5638
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | CA
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