Basic Information
| Provider Information | |||||||||
| NPI: | 1548445869 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTOLOME | ||||||||
| FirstName: | PRINCESS | ||||||||
| MiddleName: | VENTUS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | N.P. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VENTUS | ||||||||
| OtherFirstName: | PRINCESS | ||||||||
| OtherMiddleName: | OLAES | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | N.P. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14350 WHITTIER BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906052138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626961104 | ||||||||
| FaxNumber: | 5626962885 | ||||||||
| Practice Location | |||||||||
| Address1: | 14350 WHITTIER BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906052138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626961104 | ||||||||
| FaxNumber: | 5626962885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2008 | ||||||||
| LastUpdateDate: | 07/02/2010 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP 17552 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | RN 624320 | 01 | CA | REGISTERED NURSE LICENSE | OTHER | NP 17552 | 01 | CA | NURSE PRACTITIONER LICENS | OTHER |