Healthcare Provider Details

I. General information

NPI: 1114108420
Provider Name (Legal Business Name): STEVEN BARRAGAN CCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 S ATLANTIC BLVD 1
LOS ANGELES CA
90022-4004
US

IV. Provider business mailing address

942 S ATLANTIC BLVD 1
LOS ANGELES CA
90022-4004
US

V. Phone/Fax

Practice location:
  • Phone: 323-263-9700
  • Fax: 323-263-8042
Mailing address:
  • Phone: 323-263-9700
  • Fax: 323-263-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19-013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: