Provider Demographics
NPI:1861170540
Name:BARBOSA, CAROLINA (BS,ATC)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:BARBOSA
Suffix:
Gender:F
Credentials:BS,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7169 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-1842
Mailing Address - Country:US
Mailing Address - Phone:805-621-3249
Mailing Address - Fax:
Practice Address - Street 1:7169 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-1842
Practice Address - Country:US
Practice Address - Phone:805-621-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000513262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer