Healthcare Provider Details

I. General information

NPI: 1033435300
Provider Name (Legal Business Name): HUMBERTO BARRAGAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E 13TH ST
MERCED CA
95341-6250
US

IV. Provider business mailing address

PO BOX 3768
MERCED CA
95344-3768
US

V. Phone/Fax

Practice location:
  • Phone: 209-383-3381
  • Fax: 209-722-2025
Mailing address:
  • Phone: 209-725-7149
  • Fax: 209-726-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A10994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: