Individual
ELLEN BARNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
175 CONCOURSE BLVD, SANTA ROSA, CA 95403-8217
(707) 284-9206
(707) 284-9254
Mailing address
175 CONCOURSE BLVD, SANTA ROSA, CA 95403-8217
(707) 284-9206
(707) 284-9254
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A368950
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680452627
TAX ID#
CA
01
—
A368950
LICENSE #
CA
Enumeration date
01/22/2007
Last updated
11/03/2011
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