1578962064 NPI number — MRS. GUADALUPE GUILLERMINA BARATTINO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578962064 NPI number — MRS. GUADALUPE GUILLERMINA BARATTINO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARATTINO
Provider First Name:
GUADALUPE
Provider Middle Name:
GUILLERMINA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ORTIZ
Provider Other First Name:
GUADALUPE
Provider Other Middle Name:
GUILLERMINA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578962064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1415 FRUITVALE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94601-2320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-535-8400
Provider Business Mailing Address Fax Number:
510-535-8484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3311 PACIFIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVERMORE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94550-7007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-961-8045
Provider Business Practice Location Address Fax Number:
925-951-8835
Provider Enumeration Date:
08/20/2014

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: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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