Healthcare Provider Details

I. General information

NPI: 1790304111
Provider Name (Legal Business Name): MICHAEL BARBARO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MONTECILLO RD
SAN RAFAEL CA
94903-3308
US

IV. Provider business mailing address

99 MONTECILLO RD
SAN RAFAEL CA
94903-3308
US

V. Phone/Fax

Practice location:
  • Phone: 415-444-2000
  • Fax:
Mailing address:
  • Phone: 415-444-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA186439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: