Basic Information
| Provider Information | |||||||||
| NPI: | 1073070280 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARGE | ||||||||
| FirstName: | MILADY | ||||||||
| MiddleName: | FERRER | ||||||||
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| OtherLastName: | FERRER | ||||||||
| OtherFirstName: | MILADY | ||||||||
| OtherMiddleName: | ANTONIO | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2185 KINGSBURY CIR | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950544008 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 251 LLEWELLYN AVE | ||||||||
| Address2: | |||||||||
| City: | CAMPBELL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950081940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083793790 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2019 | ||||||||
| LastUpdateDate: | 02/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 688457 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.