Healthcare Provider Details

I. General information

NPI: 1174020796
Provider Name (Legal Business Name): LIZETTE BARRIENTOS PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24511 W JAYNE AVE
COALINGA CA
93210-9503
US

IV. Provider business mailing address

2910 S ASPEN ST
VISALIA CA
93277-6405
US

V. Phone/Fax

Practice location:
  • Phone: 559-934-8543
  • Fax:
Mailing address:
  • Phone: 818-268-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY28963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: