Provider Demographics
NPI:1740916576
Name:BARRIENTOS, MAURICIO A
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:A
Last Name:BARRIENTOS
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:SPARK M MATSUGANA MEDICAL CENTER
Mailing Address - Street 2:459 PATTERSON ROAD 122-MB
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1522
Mailing Address - Country:US
Mailing Address - Phone:808-433-3580
Mailing Address - Fax:
Practice Address - Street 1:SPARK M MATSUGANA MEDICAL CENTER
Practice Address - Street 2:459 PATTERSON ROAD 122-MB
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1522
Practice Address - Country:US
Practice Address - Phone:808-433-3580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-1879104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker