Basic Information
| Provider Information | |||||||||
| NPI: | 1679662035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELICES | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | YOST | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5855 OLIVAS PARK DR | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930037672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056672801 | ||||||||
| FaxNumber: | 8056411706 | ||||||||
| Practice Location | |||||||||
| Address1: | 422 ARNEILL RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930106439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053834510 | ||||||||
| FaxNumber: | 8053834511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 12/26/2013 | ||||||||
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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 | 163W00000X | 299098 | CA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 6198 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | RHM08609F | 05 | CA | MEDICAID | RHM18553H | 05 | CA | MEDICAID | ZZT40394F | 05 | CA | MEDICAID | RHM08608F | 05 | CA | MEDICAID |