Provider Demographics
NPI:1679662035
Name:ELICES, BARBARA YOST (NP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:YOST
Last Name:ELICES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-641-1706
Practice Address - Street 1:422 ARNEILL RD
Practice Address - Street 2:SUITE B
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6439
Practice Address - Country:US
Practice Address - Phone:805-383-4510
Practice Address - Fax:805-383-4511
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299098163W00000X
CA6198363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08609FMedicaid
CARHM18553HMedicaid
CAZZT40394FMedicaid
CARHM08608FMedicaid
CAS62700Medicare UPIN
CARHM08608FMedicaid
CARHM08609FMedicaid
CAWNP6198EMedicare ID - Type UnspecifiedPPIN
CAZZT40394FMedicaid
CARHM18553HMedicaid
CAWNP6198HMedicare ID - Type UnspecifiedPPIN