Basic Information
| Provider Information | |||||||||
| NPI: | 1639352859 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTOK | ||||||||
| FirstName: | BEATRIX | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4168 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195436248 | ||||||||
| FaxNumber: | 6195433511 | ||||||||
| Practice Location | |||||||||
| Address1: | 4168 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195436248 | ||||||||
| FaxNumber: | 6195433511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2007 | ||||||||
| LastUpdateDate: | 07/13/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 6353626-1205 | UT | Y | Other Service Providers | Specialist | 174400000X | 6353626-8905 | UT | N | Other Service Providers | Specialist |
No ID Information.