Provider Demographics
NPI:1568196772
Name:BARRIOS, ANDREW R (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:BARRIOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1958
Mailing Address - Street 2:
Mailing Address - City:BLACK CANYON CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85324-1958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17301 E SPRING VALLEY RD STE F
Practice Address - Street 2:
Practice Address - City:MAYER
Practice Address - State:AZ
Practice Address - Zip Code:86333-4263
Practice Address - Country:US
Practice Address - Phone:928-404-8004
Practice Address - Fax:623-374-5576
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10723363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant