Provider Demographics
NPI:1578869251
Name:BARRERA, MARIA ALICIA I (RMA/RST/ESTHETICIAN)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:ALICIA
Last Name:BARRERA
Suffix:I
Gender:F
Credentials:RMA/RST/ESTHETICIAN
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:ALICIA
Other - Last Name:BARRERA
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:RMA/RST/ESTHETICIAN
Mailing Address - Street 1:1114 IONE DR
Mailing Address - Street 2:1114 IONE DRIVE
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320-4523
Mailing Address - Country:US
Mailing Address - Phone:509-305-6943
Mailing Address - Fax:
Practice Address - Street 1:1114 IONE DRIVE
Practice Address - Street 2:
Practice Address - City:BENTON CITY
Practice Address - State:WA
Practice Address - Zip Code:99320
Practice Address - Country:US
Practice Address - Phone:509-305-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAST00002766246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist