Healthcare Provider Details

I. General information

NPI: 1477781284
Provider Name (Legal Business Name): MR. HEATH ANDREW BARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 SILVERTON RD NE
SALEM OR
97301-0100
US

IV. Provider business mailing address

550 N FLOWER ST
SANTA ANA CA
92703-2361
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-5351
  • Fax:
Mailing address:
  • Phone: 714-647-6033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number615007
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number10031294
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: