Provider Demographics
NPI:1790867349
Name:BARQUERO, DALISA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:DALISA
Middle Name:
Last Name:BARQUERO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6530
Mailing Address - Country:US
Mailing Address - Phone:602-243-7277
Mailing Address - Fax:602-276-4427
Practice Address - Street 1:303 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6530
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:602-276-4427
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ146353163W00000X
OHNP 06743163W00000X
WARN60740487363L00000X
WAAP60740488363L00000X
AZAP2749363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ274767Medicaid
Z130477Medicare PIN
AZP71067Medicare UPIN
AZ274767Medicaid
AZ118587Medicare PIN