Healthcare Provider Details

I. General information

NPI: 1124740147
Provider Name (Legal Business Name): EMILY ARAIZA-CARRAZCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 08/11/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HACKETT RD
MODESTO CA
95358-9800
US

IV. Provider business mailing address

800 SCENIC DR
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-2352
  • Fax:
Mailing address:
  • Phone: 209-525-6247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberASW124761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: