Provider Demographics
NPI:1245376854
Name:BARBOSA, J BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:J
Middle Name:BRUCE
Last Name:BARBOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 PALOMARES AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1738
Mailing Address - Country:US
Mailing Address - Phone:805-988-1443
Mailing Address - Fax:805-988-0897
Practice Address - Street 1:2945 LOMA VISTA ROAD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2915
Practice Address - Country:US
Practice Address - Phone:805-648-6851
Practice Address - Fax:805-648-6128
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA032595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A26858Medicare UPIN
A32595Medicare ID - Type Unspecified