Healthcare Provider Details

I. General information

NPI: 1740550268
Provider Name (Legal Business Name): CAROLE LUBY BARISH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 HIDDEN VALLEY PL
LA JOLLA CA
92037-4019
US

IV. Provider business mailing address

2545 HIDDEN VALLEY PL
LA JOLLA CA
92037-4019
US

V. Phone/Fax

Practice location:
  • Phone: 858-459-6520
  • Fax: 858-459-6520
Mailing address:
  • Phone: 858-459-6520
  • Fax: 858-459-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberGFE23805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: