Provider Demographics
NPI:1326847864
Name:SERVIN BARBOZA, RAMONA ELIZABETH
Entity type:Individual
Prefix:
First Name:RAMONA
Middle Name:ELIZABETH
Last Name:SERVIN BARBOZA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16345 MATADOR WAY
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-9060
Mailing Address - Country:US
Mailing Address - Phone:209-313-6109
Mailing Address - Fax:
Practice Address - Street 1:5637 N PERSHING AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4944
Practice Address - Country:US
Practice Address - Phone:408-439-6308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician