Healthcare Provider Details

I. General information

NPI: 1346779378
Provider Name (Legal Business Name): ROXANNE SHIZU BARBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11499 BARTLETT AVE
ADELANTO CA
92301-1902
US

IV. Provider business mailing address

7516 SVL BOX
VICTORVILLE CA
92395-5157
US

V. Phone/Fax

Practice location:
  • Phone: 760-444-4258
  • Fax:
Mailing address:
  • Phone: 760-885-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: