Provider Demographics
NPI:1235739343
Name:BARRERA, ERICK
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:BARRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 BEND OF THE BOSQUE RD
Mailing Address - Street 2:
Mailing Address - City:CHINA SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:76633-3269
Mailing Address - Country:US
Mailing Address - Phone:254-981-3837
Mailing Address - Fax:
Practice Address - Street 1:496 BEND OF THE BOSQUE RD
Practice Address - Street 2:
Practice Address - City:CHINA SPRING
Practice Address - State:TX
Practice Address - Zip Code:76633-3269
Practice Address - Country:US
Practice Address - Phone:254-981-3837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1008558164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse