Provider Demographics
NPI:1134247919
Name:BARTHOLOW, JOHN S (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:BARTHOLOW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 ALVARADO RD # 278
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-3616
Mailing Address - Country:US
Mailing Address - Phone:619-994-7862
Mailing Address - Fax:619-265-1802
Practice Address - Street 1:7777 ALVARADO RD # 278
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3616
Practice Address - Country:US
Practice Address - Phone:619-994-7862
Practice Address - Fax:619-265-1802
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7165103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA076407OtherTRICARE
CAPR0071650Medicaid
CAPR0071650Medicaid
CACP7165Medicare ID - Type Unspecified