Provider Demographics
NPI:1235827460
Name:BARBA, ALEXIS LUCILIA
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LUCILIA
Last Name:BARBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 MARENGO AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3811
Mailing Address - Country:US
Mailing Address - Phone:209-513-0937
Mailing Address - Fax:
Practice Address - Street 1:451 MARENGO AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-3811
Practice Address - Country:US
Practice Address - Phone:209-513-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565300163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health