Healthcare Provider Details

I. General information

NPI: 1558170589
Provider Name (Legal Business Name): DEYSI BARRIENTOS O'CONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12917 CERISE AVE
HAWTHORNE CA
90250-5520
US

IV. Provider business mailing address

9476 FOSTER RD
BELLFLOWER CA
90706-2207
US

V. Phone/Fax

Practice location:
  • Phone: 310-675-4431
  • Fax:
Mailing address:
  • Phone: 714-474-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: