Healthcare Provider Details

I. General information

NPI: 1619429834
Provider Name (Legal Business Name): KATRINA MARIE BARBOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11850 PIERCE ST STE 200
RIVERSIDE CA
92505-5184
US

IV. Provider business mailing address

11850 PIERCE ST STE 200
RIVERSIDE CA
92505-5184
US

V. Phone/Fax

Practice location:
  • Phone: 951-465-3664
  • Fax:
Mailing address:
  • Phone: 951-465-3664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number835054
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95033062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: