Healthcare Provider Details

I. General information

NPI: 1609109206
Provider Name (Legal Business Name): ADRIENNE BARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9530 WINTER GARDENS BLVD
LAKESIDE CA
92040-4032
US

IV. Provider business mailing address

9530 WINTER GARDENS BLVD
LAKESIDE CA
92040-4032
US

V. Phone/Fax

Practice location:
  • Phone: 760-566-8363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: