Provider Demographics
NPI:1568169985
Name:BARBOSE, MARC ANTHONY (ND, RPH)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANTHONY
Last Name:BARBOSE
Suffix:
Gender:M
Credentials:ND, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VISTA OUTLOOK ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-3165
Mailing Address - Country:US
Mailing Address - Phone:702-339-3487
Mailing Address - Fax:
Practice Address - Street 1:12 VISTA OUTLOOK ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-3165
Practice Address - Country:US
Practice Address - Phone:702-339-3487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
NV14251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No175F00000XOther Service ProvidersNaturopath