Provider Demographics
NPI:1871733360
Name:BARBA, LORETTE ELISE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:LORETTE
Middle Name:ELISE
Last Name:BARBA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:LAURIE(NICK NAME)
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7227 GLENVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-5808
Mailing Address - Country:US
Mailing Address - Phone:408-927-7475
Mailing Address - Fax:408-440-0043
Practice Address - Street 1:2505 SAMARITAN DRIVE SUITE #607
Practice Address - Street 2:SILICON VALLEY PEDIATRICIANS
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124
Practice Address - Country:US
Practice Address - Phone:408-356-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257702363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner