Basic Information
Provider Information
NPI: 1780023770
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARRA
FirstName: MOHSIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3687 MT DIABLO BLVD
Address2: SUITE 200
City: LAFAYETTE
State: CA
PostalCode: 945493717
CountryCode: US
TelephoneNumber: 9168546975
FaxNumber:  
Practice Location
Address1: 3901 LONE TREE WAY
Address2:  
City: ANTIOCH
State: CA
PostalCode: 945096200
CountryCode: US
TelephoneNumber: 9257561192
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/23/2013
LastUpdateDate: 03/22/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMT205008PAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000XA141532CAN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000XA141532CAY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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