Provider Demographics
NPI:1811314271
Name:BARRIENTOS, KYRA
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:
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 1:5053 LA MART DR STE 101
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-5993
Mailing Address - Country:US
Mailing Address - Phone:951-215-6552
Mailing Address - Fax:855-950-0083
Practice Address - Street 1:5053 LA MART DR STE 101
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5993
Practice Address - Country:US
Practice Address - Phone:951-215-6552
Practice Address - Fax:855-950-0083
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96883106H00000X
CA73714106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106H00000XOtherMEDICAL