Provider Demographics
NPI:1023315827
Name:BARBER, JAMELA LAVINA (DPT)
Entity type:Individual
Prefix:
First Name:JAMELA
Middle Name:LAVINA
Last Name:BARBER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6131
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:31764 CASINO DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4571
Practice Address - Country:US
Practice Address - Phone:951-471-3300
Practice Address - Fax:951-471-3301
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA193643Medicare PIN
CACA193642Medicare PIN