Healthcare Provider Details

I. General information

NPI: 1396679767
Provider Name (Legal Business Name): LUIS AMADOR BARAJAS PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27765 LANDAU BLVD STE 104 PMB 1010
CATHEDRAL CITY CA
92234
US

IV. Provider business mailing address

27765 LANDAU BLVD STE 104 PMB 1010
CATHEDRAL CITY CA
92234
US

V. Phone/Fax

Practice location:
  • Phone: 714-876-6041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95312151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: