Provider Demographics
NPI:1073375986
Name:BARTOLOME, BERNADETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:BARTOLOME
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 S PECOS RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5039
Mailing Address - Country:US
Mailing Address - Phone:725-225-5575
Mailing Address - Fax:
Practice Address - Street 1:4425 S PECOS RD STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5039
Practice Address - Country:US
Practice Address - Phone:725-225-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2892363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty