Healthcare Provider Details

I. General information

NPI: 1003832296
Provider Name (Legal Business Name): JORGE A BARRERA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 PARKWAY DR
LA MESA CA
91942-1535
US

IV. Provider business mailing address

PO BOX 1770
LA MESA CA
91944-1770
US

V. Phone/Fax

Practice location:
  • Phone: 619-291-6040
  • Fax: 858-453-6149
Mailing address:
  • Phone: 619-464-1165
  • Fax: 619-567-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA-32333
License Number StateCA

VIII. Authorized Official

Name: DR. JORGE AURELIO BARRERA
Title or Position: PRESIDENT
Credential: MD
Phone: 619-291-6040