Provider Demographics
NPI:1235249665
Name:BARTTELBORT, SCOTT WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WALTER
Last Name:BARTTELBORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE STE 730
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1218
Mailing Address - Country:US
Mailing Address - Phone:858-623-9394
Mailing Address - Fax:858-623-9091
Practice Address - Street 1:9850 GENESEE AVE STE 730
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1218
Practice Address - Country:US
Practice Address - Phone:858-623-9394
Practice Address - Fax:858-623-9091
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44844208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44844OtherSTATE LICENSE
CAFW446ZMedicare UPIN