Basic Information
| Provider Information | |||||||||
| NPI: | 1124587514 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARAI BARRIENTOS | ||||||||
| FirstName: | MADOKA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3440 LOMITA BLVD STE 320 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905054824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105348200 | ||||||||
| FaxNumber: | 3105348265 | ||||||||
| Practice Location | |||||||||
| Address1: | 3440 LOMITA BLVD STE 320 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905054824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105348200 | ||||||||
| FaxNumber: | 3105348265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2019 | ||||||||
| LastUpdateDate: | 03/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 95011268 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 95011268 | 01 | CA | BOARD OF REGISTERED NURSING | OTHER |