Provider Demographics
NPI:1700245131
Name:DECORO, BARTHOLOMEW (MD)
Entity Type:Individual
Prefix:DR
First Name:BARTHOLOMEW
Middle Name:
Last Name:DECORO
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 1:321 S HILLVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2335
Mailing Address - Country:US
Mailing Address - Phone:714-776-4211
Mailing Address - Fax:
Practice Address - Street 1:321 S HILLVIEW RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-2335
Practice Address - Country:US
Practice Address - Phone:714-577-6421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-13
Last Update Date:2016-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAD7132006174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist