Healthcare Provider Details

I. General information

NPI: 1134780620
Provider Name (Legal Business Name): RICARDO BARRIENTOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICARDO BARRIENTOS MUNOZ MD

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 NW WALL ST STE 160
BEND OR
97703-3200
US

IV. Provider business mailing address

279 BLUEGRASS DR
CULVER OR
97734-7004
US

V. Phone/Fax

Practice location:
  • Phone: 832-612-1690
  • Fax:
Mailing address:
  • Phone: 832-612-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU1640
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD209687
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10067562
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: