Provider Demographics
NPI:1376818690
Name:SCOTT W. BARTTELBORT, M.D., APC
Entity Type:Organization
Organization Name:SCOTT W. BARTTELBORT, M.D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARTTELBORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-623-9394
Mailing Address - Street 1:8929 UNIVERSITY CENTER LN
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1006
Mailing Address - Country:US
Mailing Address - Phone:858-623-9394
Mailing Address - Fax:858-623-9071
Practice Address - Street 1:8929 UNIVERSITY CENTER LN
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1006
Practice Address - Country:US
Practice Address - Phone:858-623-9394
Practice Address - Fax:858-623-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44844208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty