MEDICARE: ALYSIA CONSTANCE BARHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	163W00000X	Registered Nurse	95228329	CA

General Provider Information

NPI Number	:	1770123226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSIA CONSTANCE BARHAM

Provider Business Mailing Address
First Line	:	15 SANTA ARLETTA
Second Line	:
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-2685
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 SANTA ARLETTA
Second Line	:
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-2685
Country	:	US
Telephone Number	:	949-680-7989
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	07/31/2025

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Directions to “ ALYSIA CONSTANCE BARHAM ” Practice Location

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