Healthcare Provider Details

I. General information

NPI: 1073288437
Provider Name (Legal Business Name): KATHERINE BARBERIS AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11250 WARNER AVE # 39
FOUNTAIN VALLEY CA
92708-4116
US

IV. Provider business mailing address

4971 BONITA DR # 39
HUNTINGTON BEACH CA
92649-3585
US

V. Phone/Fax

Practice location:
  • Phone: 651-442-8132
  • Fax:
Mailing address:
  • Phone: 651-442-8132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number95018032
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number95018032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: