Healthcare Provider Details

I. General information

NPI: 1386740090
Provider Name (Legal Business Name): JUAN E BARROS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19201 AMALFI CT
WALNUT CA
91789-4204
US

IV. Provider business mailing address

19201 AMALFI CT
WALNUT CA
91789-4204
US

V. Phone/Fax

Practice location:
  • Phone: 626-810-0800
  • Fax: 626-435-0251
Mailing address:
  • Phone: 626-810-0800
  • Fax: 626-435-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JUAN E BARROS
Title or Position: OWNER
Credential: RDMS,RDCS,RVT,CCT
Phone: 626-810-0800