Healthcare Provider Details

I. General information

NPI: 1639619398
Provider Name (Legal Business Name): GONZALO ELIAZ BARRAZA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 S ROSE AVE
OXNARD CA
93033-3953
US

IV. Provider business mailing address

2851 S ROSE AVE
OXNARD CA
93033-3953
US

V. Phone/Fax

Practice location:
  • Phone: 805-483-5635
  • Fax:
Mailing address:
  • Phone: 805-483-5635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: