Provider Demographics
NPI:1215150040
Name:DEFIRMIAN, BARBARA LISA (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:LISA
Last Name:DEFIRMIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:BURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:84 SANTA ROSA ST
Mailing Address - Street 2:STE A
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1812
Mailing Address - Country:US
Mailing Address - Phone:805-542-9596
Mailing Address - Fax:805-542-9354
Practice Address - Street 1:84 SANTA ROSA ST
Practice Address - Street 2:STE A
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1812
Practice Address - Country:UM
Practice Address - Phone:805-591-4727
Practice Address - Fax:805-439-3394
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-14119207Q00000X
CAG71605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000266072OtherHMSA BILLING NUMBER
CA1841217866Medicaid
HI593914-01Medicaid
CAW1508Medicare PIN
CAE37928Medicare UPIN
CA051847Medicare Oscar/Certification
CA1841217866Medicaid