Healthcare Provider Details

I. General information

NPI: 1922000355
Provider Name (Legal Business Name): BARRY JON MASSIRIO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 CALIFORNIA AVE
BAKERSFIELD CA
93309-1104
US

IV. Provider business mailing address

4580 CALIFORNIA AVE
BAKERSFIELD CA
93309-1104
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-4411
  • Fax:
Mailing address:
  • Phone: 661-327-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: