Provider Demographics
NPI:1477744001
Name:BARRIENTOS, SONIA RAQUEL
Entity Type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:RAQUEL
Last Name:BARRIENTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6989 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3205
Mailing Address - Country:US
Mailing Address - Phone:305-861-0018
Mailing Address - Fax:305-861-0017
Practice Address - Street 1:6989 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3205
Practice Address - Country:US
Practice Address - Phone:305-861-0018
Practice Address - Fax:305-861-0017
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5686156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630386200Medicaid