MEDICARE: LUDIVINA BARIBEAU FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP142346	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649782400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUDIVINA BARIBEAU FNP

Provider Business Mailing Address
First Line	:	3320 OAKWELL CT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-3128
Country	:	US
Telephone Number	:	210-560-8897
Fax Number	:

Provider Business Practice Location Address
First Line	:	3327 RESEARCH PLZ STE 204
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78235-5157
Country	:	US
Telephone Number	:	210-829-5180
Fax Number	:	210-829-5030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2017
Last Update Date	:	02/24/2021

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