Healthcare Provider Details

I. General information

NPI: 1326499138
Provider Name (Legal Business Name): YNA BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 S ANAHEIM BLVD STE 101
ANAHEIM CA
92805-6205
US

IV. Provider business mailing address

1360 S ANAHEIM BLVD STE 101
ANAHEIM CA
92805-6205
US

V. Phone/Fax

Practice location:
  • Phone: 714-948-7641
  • Fax: 714-689-1381
Mailing address:
  • Phone: 714-948-7641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number38332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: