Healthcare Provider Details

I. General information

NPI: 1013655315
Provider Name (Legal Business Name): MISS CAROLINA BARRIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 3RD AVE
SAN DIEGO CA
92103-1407
US

IV. Provider business mailing address

5650 MOUNT ACKERLY DR
SAN DIEGO CA
92111-4016
US

V. Phone/Fax

Practice location:
  • Phone: 619-876-4502
  • Fax:
Mailing address:
  • Phone: 858-302-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: