1013095629 NPI number — DR. MARYLOUISE NONE BARROS-NISKA MFCC AND PH.D

Table of content: DR. MARYLOUISE NONE BARROS-NISKA MFCC AND PH.D (NPI 1013095629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013095629 NPI number — DR. MARYLOUISE NONE BARROS-NISKA MFCC AND PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARROS-NISKA
Provider First Name:
MARYLOUISE
Provider Middle Name:
NONE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MFCC AND PH.D
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1013095629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1034 W.14TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN PEDRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-485-3300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 SILVER SPUR RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
ROLLING HILLS ESTATES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90274-7612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-485-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2006

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: 103TC0700X , with the licence number:  PSY17723 , 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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