Healthcare Provider Details

I. General information

NPI: 1386171742
Provider Name (Legal Business Name): MR. ALBERTO DOMINGO BARAJAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E WALNUT ST
PASADENA CA
91188-0001
US

IV. Provider business mailing address

3626 E 59TH PL
HUNTINGTON PARK CA
90255-3206
US

V. Phone/Fax

Practice location:
  • Phone: 626-405-5533
  • Fax:
Mailing address:
  • Phone: 323-600-7042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: