MEDICARE: RAVEN BARTLETT

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
1	363LW0102X	Women's Health Nurse Practitioner	95011126	CA

General Provider Information

NPI Number	:	1538701321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN BARTLETT

Provider Business Mailing Address
First Line	:	825 S HILL ST APT 902
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90014-3282
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4922 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-3115
Country	:	US
Telephone Number	:	323-201-9343
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2019
Last Update Date	:	10/13/2019

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Directions to “ RAVEN BARTLETT ” Practice Location

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