Healthcare Provider Details

I. General information

NPI: 1790189967
Provider Name (Legal Business Name): MALENA BARCA RAS INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 AUBURN BLVD
SACRAMENTO CA
95841-4139
US

IV. Provider business mailing address

11 PEACH DR
SALINAS CA
93901-3710
US

V. Phone/Fax

Practice location:
  • Phone: 916-473-5764
  • Fax:
Mailing address:
  • Phone: 831-753-5135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRI-W1401070946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: