Healthcare Provider Details

I. General information

NPI: 1457588964
Provider Name (Legal Business Name): ANGELLA BARR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 UNIVERSITY AVE
SACRAMENTO CA
95825-6724
US

IV. Provider business mailing address

455 UNIVERSITY AVE STE 320
SACRAMENTO CA
95825-6580
US

V. Phone/Fax

Practice location:
  • Phone: 917-301-5917
  • Fax:
Mailing address:
  • Phone: 917-301-5917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA103265
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number2012042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: