Healthcare Provider Details

I. General information

NPI: 1710968425
Provider Name (Legal Business Name): OPHELIA G BARTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27141 HIDAWAY AVE #203
CANYON COUNTRY CA
91351-4131
US

IV. Provider business mailing address

PO BOX 220243
NEWHALL CA
91322-0243
US

V. Phone/Fax

Practice location:
  • Phone: 661-424-1774
  • Fax: 661-424-1711
Mailing address:
  • Phone: 661-424-1774
  • Fax: 661-424-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA43189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: