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General NPI Number Information
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NPI Number | 1669812467
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Entity Type | Individual
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Provider Name | REVERY P BARNES MD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 5850 S MAIN ST
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City | LOS ANGELES
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State | CA
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Zip | 90003-1215
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Country | US
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Telephone | 323-250-3023
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Fax |
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Provider Business Mailing Address
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Address Line | 5850 S MAIN ST
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City | LOS ANGELES
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State | CA
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Zip | 90003-1215
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Country | US
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Telephone | 323-897-6080
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Fax | 213-238-0210
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A141701
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License Number State | CA
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