Healthcare Provider Details

I. General information

NPI: 1912414145
Provider Name (Legal Business Name): RACHEL BARRAZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 LONG BEACH BLVD STE 101
LONG BEACH CA
90807-5410
US

IV. Provider business mailing address

3950 LONG BEACH BLVD STE 101
LONG BEACH CA
90807-5410
US

V. Phone/Fax

Practice location:
  • Phone: 562-684-2106
  • Fax:
Mailing address:
  • Phone: 562-684-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: