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General NPI Number Information
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NPI Number | 1104412543
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Entity Type | Individual
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Provider Name | VANESSA BARKLEY
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Gender | Female
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Dates
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Enumeration Date | 12/20/2020
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 400 N PEPPER AVE
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City | COLTON
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State | CA
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Zip | 92324-1801
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Country | US
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Telephone | 909-580-1775
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Fax | 909-580-2377
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Provider Business Mailing Address
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Address Line | 400 N PEPPER AVE # 205
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City | COLTON
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State | CA
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Zip | 92324-1801
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Country | US
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Telephone | 909-580-3390
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Fax | 909-580-6369
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA60577
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60577
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License Number State | CA
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