Healthcare Provider Details

I. General information

NPI: 1760587489
Provider Name (Legal Business Name): SEAN A. BARLOW, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41990 COOK ST, BLDG F, SUITE 2008
PALM DESERT CA
92234
US

IV. Provider business mailing address

41990 COOK ST, BLDG. F, SUITE 2008
PALM DESERT CA
92211
US

V. Phone/Fax

Practice location:
  • Phone: 760-674-9777
  • Fax: 760-674-0355
Mailing address:
  • Phone: 760-674-9777
  • Fax: 760-674-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberGO782496
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberG078296
License Number StateCA

VIII. Authorized Official

Name: DR. SEAN ARTHUR BARLOW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-674-9777