Provider Demographics
NPI:1750531265
Name:BARTOLOZZI, JOHN NICHOLAS (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:NICHOLAS
Last Name:BARTOLOZZI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3320
Mailing Address - Country:US
Mailing Address - Phone:213-284-3200
Mailing Address - Fax:704-512-6851
Practice Address - Street 1:400 W 30TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3320
Practice Address - Country:US
Practice Address - Phone:213-284-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51357363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750531265Medicaid
SC0941PAMedicaid
NC8101297Medicaid
NC2762187Medicare PIN
NC2762187FMedicare PIN
NC2762187GMedicare PIN
NC2762187CMedicare PIN
NC2762187JMedicare PIN
NC2762187DMedicare PIN
NC2762187EMedicare PIN
NC2762187MMedicare PIN
SC0941PAMedicaid
NC8101297Medicaid
NC2762187NMedicare PIN
NC2762187KMedicare PIN
NC2762187BMedicare PIN
NCNC4976CMedicare PIN
NCNC4976BMedicare PIN
NC1750531265Medicaid
NC2762187HMedicare PIN
NC2762187LMedicare PIN
NC2762187PMedicare PIN