Basic Information
| Provider Information | |||||||||
| NPI: | 1215150040 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEFIRMIAN | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | LISA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BURG | ||||||||
| OtherFirstName: | BARBARA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 84 SANTA ROSA ST | ||||||||
| Address2: | STE A | ||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934051812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055429596 | ||||||||
| FaxNumber: | 8055429354 | ||||||||
| Practice Location | |||||||||
| Address1: | 84 SANTA ROSA ST | ||||||||
| Address2: | STE A | ||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934051812 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 8055914727 | ||||||||
| FaxNumber: | 8054393394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 04/12/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD-14119 | HI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | G71605 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0000266072 | 01 | HI | HMSA BILLING NUMBER | OTHER | 1841217866 | 05 | CA | MEDICAID | 593914-01 | 05 | HI | MEDICAID |