Provider Demographics
NPI:1710264247
Name:DIBARTOLOMEO, RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:
Last Name:DIBARTOLOMEO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 BELOIT AVE
Mailing Address - Street 2:#210
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4257
Mailing Address - Country:US
Mailing Address - Phone:213-709-4729
Mailing Address - Fax:
Practice Address - Street 1:2420 CASTILLO ST
Practice Address - Street 2:STE 100
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4346
Practice Address - Country:US
Practice Address - Phone:805-563-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 31765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor