Healthcare Provider Details

I. General information

NPI: 1952505000
Provider Name (Legal Business Name): CHRISTINA DENISE BARRAZA COUNSELOR INTERN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 E ALBERTONI ST SUITE 200
CARSON CA
90746-1539
US

IV. Provider business mailing address

13707 DOTY AVE APT 32
HAWTHORNE CA
90250-7552
US

V. Phone/Fax

Practice location:
  • Phone: 310-217-0616
  • Fax: 310-217-0545
Mailing address:
  • Phone: 310-679-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: