Provider Demographics
NPI:1841428265
Name:BARNES, MAYRA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8418 LAKE BOSSE DR.
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810
Mailing Address - Country:US
Mailing Address - Phone:407-595-9505
Mailing Address - Fax:407-292-8470
Practice Address - Street 1:8418 LAKE BOSSE DR.
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810
Practice Address - Country:US
Practice Address - Phone:407-595-9505
Practice Address - Fax:407-292-8470
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA53355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000696800Medicaid