Healthcare Provider Details

I. General information

NPI: 1063762599
Provider Name (Legal Business Name): LUIS ALBERTO BARRAGAN I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7170 N. FINANCIAL DR SUIT 135
FRESNO CA
93270
US

IV. Provider business mailing address

7170 N. FINANCIAL DR SUIT 135
FRESNO CA
93270
US

V. Phone/Fax

Practice location:
  • Phone: 559-221-8100
  • Fax:
Mailing address:
  • Phone: 559-221-8100
  • 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: