Healthcare Provider Details

I. General information

NPI: 1073227864
Provider Name (Legal Business Name): GRISELDA BARAHONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WILSHIRE BLVD STE 210
LOS ANGELES CA
90017-1931
US

IV. Provider business mailing address

1200 WILSHIRE BLVD STE 210
LOS ANGELES CA
90017-1931
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-7464
  • Fax:
Mailing address:
  • Phone: 213-481-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: