Provider Demographics
NPI:1548445869
Name:BARTOLOME, PRINCESS VENTUS (NP)
Entity type:Individual
Prefix:
First Name:PRINCESS
Middle Name:VENTUS
Last Name:BARTOLOME
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PRINCESS
Other - Middle Name:OLAES
Other - Last Name:VENTUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:14350 WHITTIER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2138
Mailing Address - Country:US
Mailing Address - Phone:562-696-1104
Mailing Address - Fax:562-696-2885
Practice Address - Street 1:14350 WHITTIER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2138
Practice Address - Country:US
Practice Address - Phone:562-696-1104
Practice Address - Fax:562-696-2885
Is Sole Proprietor?:No
Enumeration Date:2008-01-05
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 17552363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN 624320OtherREGISTERED NURSE LICENSE
CANP 17552OtherNURSE PRACTITIONER LICENS