Healthcare Provider Details

I. General information

NPI: 1366748683
Provider Name (Legal Business Name): BARBARA JEANNE WALTERS RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 REDBIRD DR
SAN JOSE CA
95125-2824
US

IV. Provider business mailing address

887 REDBIRD DR
SAN JOSE CA
95125-2824
US

V. Phone/Fax

Practice location:
  • Phone: 408-888-4610
  • Fax: 408-264-8165
Mailing address:
  • Phone: 408-888-4610
  • Fax: 408-264-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: