Basic Information
| Provider Information | |||||||||
| NPI: | 1255875795 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARBOSA | ||||||||
| FirstName: | MARISOL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1957 ARCADIA CT | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939065415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086881373 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1957 ARCADIA CT | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939065415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075744629 | ||||||||
| FaxNumber: | 4079654480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2016 | ||||||||
| LastUpdateDate: | 04/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 106E00000X | 0-16-7465 | CA | N |
No ID Information.