Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | 4301076436 | MI |
Y | 2080P0210X | Pediatric Nephrologist | 43741 | AZ |
NPI | 1417921131 |
---|---|
Provider Name | Dr. Gina-Marie Barletta |
First Address | Phoenix, AZ 85016-7969 |
Second Address | Phoenix, AZ 85018-2322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 17/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
580589 | (05) | AZ |