Provider Demographics
NPI:1083048169
Name:BARBER, MARISA N (PA-C)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:N
Last Name:BARBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:NICOLE
Other - Last Name:LANDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:860 OAK PARK BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1800
Mailing Address - Country:US
Mailing Address - Phone:805-481-3685
Mailing Address - Fax:805-481-5245
Practice Address - Street 1:860 OAK PARK BLVD
Practice Address - Street 2:STE 101
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1800
Practice Address - Country:US
Practice Address - Phone:805-481-3685
Practice Address - Fax:805-481-5245
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23039363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant