Basic Information
| Provider Information | |||||||||
| NPI: | 1407286503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRERA | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3360 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972083360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667472455 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19200 N KELSEY ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607947994 | ||||||||
| FaxNumber: | 3608054757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2013 | ||||||||
| LastUpdateDate: | 02/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OP60560271 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0401X | 13046 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207QA0401X | OP60560271 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine |
No ID Information.