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NPI Code Detail

MEDICARE: MICAIAH BARTHOLOMEW

MEDICARE: MICAIAH BARTHOLOMEW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1184559163
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICAIAH BARTHOLOMEW
Provider Business Mailing Address
First Line : 1737 ATLANTA AVE STE H5
Second Line :
City : RIVERSIDE
State : CA
Zip : 92507-2419
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1737 ATLANTA AVE STE H5
Second Line :
City : RIVERSIDE
State : CA
Zip : 92507-2419
Country : US
Telephone Number : 951-405-3015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2026
Last Update Date : 06/12/2026

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Directions to “ MICAIAH BARTHOLOMEW ” Practice Location

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