Provider Demographics
NPI:1841029105
Name:BARKER-BIGBY, VIVIANNA-ELISA
Entity type:Individual
Prefix:
First Name:VIVIANNA-ELISA
Middle Name:
Last Name:BARKER-BIGBY
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 1:3930 GENEVIEVE ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-2375
Mailing Address - Country:US
Mailing Address - Phone:818-923-7080
Mailing Address - Fax:
Practice Address - Street 1:165 W HOSPITALITY LN STE 27
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3326
Practice Address - Country:US
Practice Address - Phone:442-327-9172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician