Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | N5556 | TX |
Y | 207RP1001X | Pulmonary Disease | N5556 | TX |
NPI | 1013093293 |
---|---|
Provider Name | Sonja D Bartolome |
First Address | Dallas, TX 75390-7201 |
Second Address | Dallas, TX 75390-7201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 16/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100419960A | (05) | KS |
104132 | (02) | TX |
31420031 | BCBS KC (01) | MO |
H59764 | (02) |