Healthcare Provider Details

I. General information

NPI: 1215325303
Provider Name (Legal Business Name): MARGIE BARBOZA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2014
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27442 PORTOLA PKWY STE 200
FOOTHILL RANCH CA
92610-2822
US

IV. Provider business mailing address

27442 PORTOLA PARKWAY, SUITE 200
FOOTHILL RANCH CA
92610
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-9202
  • Fax:
Mailing address:
  • Phone: 714-871-9202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number9241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: