1407171135 NPI number — MS. JESSICA MONIQUE-SEABURY BARNETT P.A-C

Table of content: MS. JESSICA MONIQUE-SEABURY BARNETT P.A-C (NPI 1407171135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407171135 NPI number — MS. JESSICA MONIQUE-SEABURY BARNETT P.A-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARNETT
Provider First Name:
JESSICA
Provider Middle Name:
MONIQUE-SEABURY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.A-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEABURY
Provider Other First Name:
JESSICA
Provider Other Middle Name:
MONIQUE
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:
1407171135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1691 THE ALAMEDA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95126-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-795-3619
Provider Business Mailing Address Fax Number:
408-287-0405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1691 THE ALAMEDA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95126-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-287-7526
Provider Business Practice Location Address Fax Number:
408-971-6963
Provider Enumeration Date:
04/06/2010

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: 363A00000X , with the licence number:  20906 , 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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