Healthcare Provider Details

I. General information

NPI: 1407997844
Provider Name (Legal Business Name): MRS. AMELIA BARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY BARRETT

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 S GRAND AVE
GLENDORA CA
91740-5000
US

IV. Provider business mailing address

6902 EASTWOOD AVE
ALTA LOMA CA
91701-4805
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-5980
  • Fax: 626-335-5989
Mailing address:
  • Phone: 626-995-5980
  • Fax: 626-335-5989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: