Provider Demographics
NPI:1750474557
Name:BARRETT, VIRGINIA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LYNN
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2025 E ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4670
Mailing Address - Country:US
Mailing Address - Phone:626-335-4610
Mailing Address - Fax:626-914-1051
Practice Address - Street 1:2025 E ROUTE 66
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4670
Practice Address - Country:US
Practice Address - Phone:626-335-4610
Practice Address - Fax:626-914-1051
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG35230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-4526112OtherTAX ID