Provider Demographics
NPI:1538153499
Name:BARBARA FLORENTINE MD A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:BARBARA FLORENTINE MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLORENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-200-9110
Mailing Address - Street 1:5921 WILKINSON AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1135
Mailing Address - Country:US
Mailing Address - Phone:818-200-9110
Mailing Address - Fax:818-301-2546
Practice Address - Street 1:5921 WILKINSON AVE
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-1135
Practice Address - Country:US
Practice Address - Phone:818-200-9110
Practice Address - Fax:818-301-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A479580Medicaid
CA00A479580Medicaid
CABO947BMedicare PIN
CABN757VMedicare PIN