Provider Demographics
NPI:1306574090
Name:BULAN-BARTOLOME, JANICE MANRIQUE (FNP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:MANRIQUE
Last Name:BULAN-BARTOLOME
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 OTAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2840
Mailing Address - Country:US
Mailing Address - Phone:650-759-4607
Mailing Address - Fax:
Practice Address - Street 1:1750 EL CAMINO REAL STE 202
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3214
Practice Address - Country:US
Practice Address - Phone:650-692-9751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95021485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily