Healthcare Provider Details

I. General information

NPI: 1780130450
Provider Name (Legal Business Name): LIDIA GABRIELA BARAJAS GONZALEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 E 12TH ST
OAKLAND CA
94601-3463
US

IV. Provider business mailing address

27365 TYRRELL AVE
HAYWARD CA
94544-4511
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-4000
  • Fax:
Mailing address:
  • Phone: 510-460-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95075705
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95075705
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number95075705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: