Individual
ANTOINETTE CARMEN SAN BARTOLOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
901 OAK PARK BOULEVARD, SUITE 101, PISMO BEACH, CA 93449-3409
(805) 489-2205
(805) 489-2206
Mailing address
P.O. BOX 1410, PISMO BEACH, CA 93448-1410
(805) 489-2205
(805) 489-2206
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A87054
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A87054
MEDICAL LICENSE
CA
Enumeration date
05/01/2007
Last updated
03/07/2023
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