Provider Demographics
NPI:1568934958
Name:BARROSO, BRICEL
Entity Type:Individual
Prefix:
First Name:BRICEL
Middle Name:
Last Name:BARROSO
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 1:870 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-5902
Mailing Address - Country:US
Mailing Address - Phone:408-843-6005
Mailing Address - Fax:
Practice Address - Street 1:9360 N NAME UNO STE 130
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3535
Practice Address - Country:US
Practice Address - Phone:408-843-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-22
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF5230314OtherVALLEY HEALTH PLAN