Healthcare Provider Details

I. General information

NPI: 1538909957
Provider Name (Legal Business Name): ROBERTHA CAROL BARNES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 05/31/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 BROADWAY
OAKLAND CA
94611-5798
US

IV. Provider business mailing address

1255 N GOODMAN ST # 407
ROCHESTER NY
14609-3541
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1200
  • Fax:
Mailing address:
  • Phone: 585-709-8249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: