1720296056 NPI number — DR. JOANNE PATRICIA BARGE PH.D., MSED

Table of content: DR. JOANNE PATRICIA BARGE PH.D., MSED (NPI 1720296056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720296056 NPI number — DR. JOANNE PATRICIA BARGE PH.D., MSED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARGE
Provider First Name:
JOANNE
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., MSED
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:
1720296056
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:
12011 SAN VICENTE BLVD
Provider Second Line Business Mailing Address:
SUITE 510
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90049-4926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-472-2329
Provider Business Mailing Address Fax Number:
310-472-1399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12011 SAN VICENTE BLVD
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90049-4926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-472-2329
Provider Business Practice Location Address Fax Number:
310-472-1399
Provider Enumeration Date:
05/18/2007

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: 103T00000X , with the licence number:  PSY 14116 , 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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