Healthcare Provider Details

I. General information

NPI: 1770003618
Provider Name (Legal Business Name): MRS. ELIZABETH BARBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2164 N MOUNTAIN VIEW AVE
SAN BERNARDINO CA
92405-4019
US

IV. Provider business mailing address

2164 N MOUNTAIN VIEW AVE
SAN BERNARDINO CA
92405-4019
US

V. Phone/Fax

Practice location:
  • Phone: 909-886-2994
  • Fax:
Mailing address:
  • Phone: 909-886-2994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: