1861602575 NPI number — MS. BARRIE HELEN ABBOTT PA-C

Table of content: MS. BARRIE HELEN ABBOTT PA-C (NPI 1861602575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861602575 NPI number — MS. BARRIE HELEN ABBOTT PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABBOTT
Provider First Name:
BARRIE
Provider Middle Name:
HELEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABBOTT
Provider Other First Name:
BARRIE
Provider Other Middle Name:
HELEN
Provider Other Name Prefix Text:
PROF.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1861602575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 390984
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANZA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92539-0984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-551-6118
Provider Business Mailing Address Fax Number:
951-763-5700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58581 US HIGHWAY 371 STE F
Provider Second Line Business Practice Location Address:
STE F, G, H
Provider Business Practice Location Address City Name:
ANZA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92539-9331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-763-4759
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2007

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: 363A00000X , with the licence number:  PA10802 , 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)

  • Identifier: 1861602575 . This is a "NPPES NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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