Healthcare Provider Details

I. General information

NPI: 1275191496
Provider Name (Legal Business Name): MS. ARIANA GUADALUPE BARAJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date: 05/07/2024
Reactivation Date: 05/24/2024

III. Provider practice location address

3210 LONG BEACH BLVD
LONG BEACH CA
90807-5062
US

IV. Provider business mailing address

3210 LONG BEACH BLVD
LONG BEACH CA
90807-5062
US

V. Phone/Fax

Practice location:
  • Phone: 562-548-6500
  • Fax:
Mailing address:
  • Phone: 562-548-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC15323
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: