Provider Demographics
NPI:1750527149
Name:BARNARD, ZELLA MONDO
Entity type:Individual
Prefix:
First Name:ZELLA
Middle Name:MONDO
Last Name:BARNARD
Suffix:
Gender:F
Credentials:
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 723
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-0723
Mailing Address - Country:US
Mailing Address - Phone:209-756-3677
Mailing Address - Fax:209-357-0747
Practice Address - Street 1:800 W 20TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-3640
Practice Address - Country:US
Practice Address - Phone:209-756-3677
Practice Address - Fax:209-357-0747
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11206225700000X
CA52094225700000X
CA50629225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist