Provider Demographics
NPI:1811367261
Name:BARIEL, JEFFREY BRYAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRYAN
Last Name:BARIEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6809
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93412-6809
Mailing Address - Country:US
Mailing Address - Phone:805-459-5606
Mailing Address - Fax:
Practice Address - Street 1:1480 10TH ST
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-1704
Practice Address - Country:US
Practice Address - Phone:805-459-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52836363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical