Healthcare Provider Details

I. General information

NPI: 1710626676
Provider Name (Legal Business Name): JACQUELINE BARRAZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 09/10/2025
Certification Date: 10/19/2023
Deactivation Date: 06/30/2025
Reactivation Date: 09/10/2025

III. Provider practice location address

2116 ARLINGTON AVE STE 100
LOS ANGELES CA
90018-1300
US

IV. Provider business mailing address

2116 ARLINGTON AVE STE 100
LOS ANGELES CA
90018-1300
US

V. Phone/Fax

Practice location:
  • Phone: 323-334-9000
  • Fax:
Mailing address:
  • Phone: 323-334-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142137
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: