Provider Demographics
NPI:1447517065
Name:BARBOSA, MARIA D (NP)
Entity type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:D
Last Name:BARBOSA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 LOMA DR APT 2
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-4652
Mailing Address - Country:US
Mailing Address - Phone:909-472-5843
Mailing Address - Fax:
Practice Address - Street 1:651 LOMA DR APT 2
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-4652
Practice Address - Country:US
Practice Address - Phone:909-472-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily