Provider Demographics
NPI:1073398608
Name:BARKER, MADELINE VICTORINE
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:VICTORINE
Last Name:BARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:VICTORINE
Other - Last Name:SALBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 S VAL VISTA DR STE A3-527
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-0944
Mailing Address - Country:US
Mailing Address - Phone:602-218-5278
Mailing Address - Fax:844-218-4691
Practice Address - Street 1:428 S GILBERT RD STE 106-2
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2263
Practice Address - Country:US
Practice Address - Phone:602-218-5278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86345544133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered