Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | A89818 | CA |
NPI | 1154420024 |
---|---|
Provider Name | Dr. Mario Fernando San Bartolome JR. |
First Address | Westminster, CA 92683-1887 |
Second Address | Westminster, CA 92683-1887 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 08/08/2019 |