Provider Demographics
NPI:1760493407
Name:BARGA, PATRICK M (AU)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:BARGA
Suffix:
Gender:M
Credentials:AU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:866-681-0736
Mailing Address - Fax:
Practice Address - Street 1:2030 SUTTER PL
Practice Address - Street 2:SUITE 1300
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6212
Practice Address - Country:US
Practice Address - Phone:530-753-3228
Practice Address - Fax:530-750-3314
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1972231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0019720Medicaid
CAP40050Medicare UPIN
CAZZZ22803ZMedicare ID - Type Unspecified
CAZZZ21435ZMedicare ID - Type UnspecifiedPRIVATE PRACTICE MEDICARE