Basic Information
| Provider Information | |||||||||
| NPI: | 1497250617 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARBA | ||||||||
| FirstName: | STEPHANNE | ||||||||
| MiddleName: | NOEMMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1383 N NORTHSTAR AVE | ||||||||
| Address2: | |||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923246635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092135519 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9445 FAIRWAY VIEW PL | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917300929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099832020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2018 | ||||||||
| LastUpdateDate: | 08/25/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 06/21/2022 | ||||||||
| NPIReactivationDate: | 08/25/2022 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 133183 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106S00000X | N |
No ID Information.