Provider Demographics
NPI:1912579210
Name:BARRIENTOS, EIZELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:EIZELLE
Middle Name:
Last Name:BARRIENTOS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2661
Mailing Address - Country:US
Mailing Address - Phone:650-515-0215
Mailing Address - Fax:
Practice Address - Street 1:1700 CALIFORNIA ST STE 440
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4592
Practice Address - Country:US
Practice Address - Phone:415-359-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21621225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty