Healthcare Provider Details

I. General information

NPI: 1720654379
Provider Name (Legal Business Name): MONIQUE ELISA BARAJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date: 04/03/2026
Reactivation Date: 05/12/2026

III. Provider practice location address

301 E 13TH ST
MERCED CA
95341-6211
US

IV. Provider business mailing address

PO BOX 399318
SAN FRANCISCO CA
94139-9318
US

V. Phone/Fax

Practice location:
  • Phone: 209-381-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: