Healthcare Provider Details

I. General information

NPI: 1730721184
Provider Name (Legal Business Name): KATIE MARIE BARBERI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 MOUNTAIN OAK PL
NEWBURY PARK CA
91320-3569
US

IV. Provider business mailing address

1072 MOUNTAIN OAK PL
NEWBURY PARK CA
91320-3569
US

V. Phone/Fax

Practice location:
  • Phone: 303-913-4573
  • Fax:
Mailing address:
  • Phone: 303-913-4573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: