Provider Demographics
NPI:1578227351
Name:BARTON, ELSIE BEDOLLA
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:BEDOLLA
Last Name:BARTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 S D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3257
Mailing Address - Country:US
Mailing Address - Phone:909-645-1497
Mailing Address - Fax:
Practice Address - Street 1:1585 S D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3257
Practice Address - Country:US
Practice Address - Phone:909-645-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator