Healthcare Provider Details

I. General information

NPI: 1790485647
Provider Name (Legal Business Name): MARON LEE BARRETT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1546 6TH
TWENTYNINE PALMS CA
92277
US

IV. Provider business mailing address

2953 BORDER AVE
JOSHUA TREE CA
92252-1119
US

V. Phone/Fax

Practice location:
  • Phone: 760-830-2542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number6434
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: