=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962631531
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | X.O. BARRIOS, MD A PROF CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2009
-----------------------------------------------------
Last Update Date | 12/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2480 MISSION ST SUITE 212
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94110-2468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-282-0441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2480 MISSION ST SUITE 212
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94110-2468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-282-0441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. XAVIER O BARRIOS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 415-282-0441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | C19656
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------