Healthcare Provider Details

I. General information

NPI: 1740768860
Provider Name (Legal Business Name): MARTHA ISABEL BARRAZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40700 CALIFORNIA OAKS RD STE 202203
MURRIETA CA
92562-5795
US

IV. Provider business mailing address

40700 CALIFORNIA OAKS RD STE 202203
MURRIETA CA
92562-5795
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-5072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number00071754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: