Healthcare Provider Details

I. General information

NPI: 1134952476
Provider Name (Legal Business Name): JEANELL BARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2781 W RAMSEY ST STE 103&104
BANNING CA
92220-3700
US

IV. Provider business mailing address

2781 W RAMSEY ST STE 103&104
BANNING CA
92220-3700
US

V. Phone/Fax

Practice location:
  • Phone: 951-417-6612
  • Fax:
Mailing address:
  • Phone: 951-417-6612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: