Provider Demographics
NPI:1861602575
Name:ABBOTT, BARRIE HELEN (PA-C)
Entity type:Individual
Prefix:MS
First Name:BARRIE
Middle Name:HELEN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:PROF
Other - First Name:BARRIE
Other - Middle Name:HELEN
Other - Last Name:ABBOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 390984
Mailing Address - Street 2:
Mailing Address - City:ANZA
Mailing Address - State:CA
Mailing Address - Zip Code:92539-0984
Mailing Address - Country:US
Mailing Address - Phone:951-551-6118
Mailing Address - Fax:951-763-5700
Practice Address - Street 1:58581 US HIGHWAY 371 STE F
Practice Address - Street 2:STE F, G, H
Practice Address - City:ANZA
Practice Address - State:CA
Practice Address - Zip Code:92539-9331
Practice Address - Country:US
Practice Address - Phone:951-763-4759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10802363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1861602575OtherNPPES NPI
CA1861602575OtherNPPES NPI