Provider Demographics
NPI:1801007083
Name:MORITA, BARBARA GLORIA (PA)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:GLORIA
Last Name:MORITA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:GLORIA
Other - Last Name:MORITA-WAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1154 HOPKINS ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1358
Mailing Address - Country:US
Mailing Address - Phone:510-524-3531
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY HEALTH SERVICES
Practice Address - Street 2:2222 BANCROFT WAY
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4300
Practice Address - Country:US
Practice Address - Phone:510-642-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10473363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant