=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649633017
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA BARBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2016
-----------------------------------------------------
Last Update Date | 04/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 68-3587 HAENA STREET
-----------------------------------------------------
City | WAIKOLOA VILLAGE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96738-4383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-782-6927
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 384383
-----------------------------------------------------
City | WAIKOLOA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96738-4383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-782-6927
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------