Provider Demographics
NPI:1134340201
Name:BARRETT, ROGER OLIVER ABELLANA (PA)
Entity type:Individual
Prefix:
First Name:ROGER OLIVER
Middle Name:ABELLANA
Last Name:BARRETT
Suffix:
Gender:M
Credentials:PA
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 1730
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1058
Mailing Address - Country:US
Mailing Address - Phone:760-568-2684
Mailing Address - Fax:760-341-5832
Practice Address - Street 1:151 S SUNRISE WAY STE 100
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-0129
Practice Address - Country:US
Practice Address - Phone:760-568-2684
Practice Address - Fax:760-341-5832
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 16145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP50806Medicare UPIN