Individual provider Active NPI

Laura Lara Bartolo

  • Speech-Language Pathologist
  • Sacramento, CA
National Provider Identifier
1396488060
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
32492 Issued in CA
Practice address
3705 PO River Way
Sacramento, CA 95834-7623
Phone
(916) 868-4139
NPI assigned
Apr 19, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 32492 CA Primary

Addresses

Primary practice location

3705 PO River Way
Sacramento, CA 95834-7623

Mailing address

3705 PO River Way
Sacramento, CA 95834-7623
Phone (916) 868-4139

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220607001201 CA Practitioner - Qualified Speech Language Pathologist 5890173652 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
32492CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation CurrentSince May 1, 2022 Accepting new patients
Sutter Valley Medical Foundation CurrentSince May 1, 2022 Accepting new patients

Locations

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

1625 Stockton Blvd
Ste 103
Sacramento, CA 95816
Phone (916) 262-9040

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1396488060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3705 PO RIVER WAY",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958347623",
            "telephone_number": "916-868-4139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3705 PO RIVER WAY",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958347623",
            "telephone_number": "916-868-4139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARA BARTOLO",
        "first_name": "LAURA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-19",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "32492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.