Provider Demographics
NPI:1669561858
Name:BARTLETT, CONNIE P (DO)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:P
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W LA VETA AVE
Mailing Address - Street 2:700
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4213
Mailing Address - Country:US
Mailing Address - Phone:714-288-3230
Mailing Address - Fax:714-744-5294
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:700
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4213
Practice Address - Country:US
Practice Address - Phone:714-288-3230
Practice Address - Fax:714-744-5294
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6599208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20A6599CMedicare ID - Type Unspecified
CAG10940Medicare UPIN