1194262303 NPI number — MARLINE BARROWS

Table of content: MARLINE BARROWS (NPI 1194262303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194262303 NPI number — MARLINE BARROWS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARROWS
Provider First Name:
MARLINE
Provider Middle Name:
Provider Name Prefix Text:
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:
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:
1194262303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19083 BEAR VALLEY RD STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APPLE VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92308-2719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-240-5700
Provider Business Mailing Address Fax Number:
760-240-7900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1408 INDUSTRIAL PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDLANDS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92374-4517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-247-1120
Provider Business Practice Location Address Fax Number:
909-635-6624
Provider Enumeration Date:
01/25/2017

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: 237700000X , with the licence number:  HA 7628 , 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)