Healthcare Provider Details

I. General information

NPI: 1861891483
Provider Name (Legal Business Name): DR. MAURO BARACHETTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 N AVALON BLVD
WILMINGTON CA
90744-4503
US

IV. Provider business mailing address

1322 N AVALON BLVD
WILMINGTON CA
90744-2639
US

V. Phone/Fax

Practice location:
  • Phone: 310-513-1300
  • Fax:
Mailing address:
  • Phone: 714-989-3002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: