Healthcare Provider Details

I. General information

NPI: 1275803587
Provider Name (Legal Business Name): BARR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4629 CASS ST # 145
SAN DIEGO CA
92109-2805
US

IV. Provider business mailing address

4629 CASS ST # 145
SAN DIEGO CA
92109-2805
US

V. Phone/Fax

Practice location:
  • Phone: 855-266-2300
  • Fax:
Mailing address:
  • Phone: 855-266-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MR. KORBEN JOSEPH KONRADY
Title or Position: PRESIDENT
Credential:
Phone: 858-220-0038