1073735379 NPI number — MS. RIVKAH LYNN BARMORE MFTI

Table of content: MS. RIVKAH LYNN BARMORE MFTI (NPI 1073735379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073735379 NPI number — MS. RIVKAH LYNN BARMORE MFTI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARMORE
Provider First Name:
RIVKAH
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFTI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAMMAN
Provider Other First Name:
RIVKAK
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073735379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 81
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT SHASTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-312-2036
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 S OREGON
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
YREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-842-3455
Provider Business Practice Location Address Fax Number:
530-842-7917
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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