Provider Demographics
NPI:1558729145
Name:BARNES, SOPHIE EATH (NP-C)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:EATH
Last Name:BARNES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:EATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:365 LENNON LN
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5910
Mailing Address - Country:US
Mailing Address - Phone:925-932-6330
Mailing Address - Fax:925-932-0139
Practice Address - Street 1:2021 MT DIABLO BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4301
Practice Address - Country:US
Practice Address - Phone:925-930-9978
Practice Address - Fax:925-930-9663
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA186188Medicare PIN