Provider Demographics
NPI:1700990306
Name:BARCENILLA, LYDIA SANCHEZ (MD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:SANCHEZ
Last Name:BARCENILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 N 1ST ST STE 114
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3947
Mailing Address - Country:US
Mailing Address - Phone:559-435-6280
Mailing Address - Fax:
Practice Address - Street 1:6700 N 1ST ST STE 114
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3947
Practice Address - Country:US
Practice Address - Phone:559-435-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA358950208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF26309Medicare UPIN