Provider Demographics
NPI:1043689193
Name:BARENG, JOY VISCIA VICTORIA (RPH)
Entity type:Individual
Prefix:
First Name:JOY VISCIA VICTORIA
Middle Name:
Last Name:BARENG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 OAKDALE RD APT 87
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2980
Mailing Address - Country:US
Mailing Address - Phone:408-839-8303
Mailing Address - Fax:
Practice Address - Street 1:16858 GOLDEN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330
Practice Address - Country:US
Practice Address - Phone:209-242-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist