Healthcare Provider Details

I. General information

NPI: 1295672871
Provider Name (Legal Business Name): ISRAEL BARRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 N LAKE AVE
PASADENA CA
91104-5020
US

IV. Provider business mailing address

124 PAINTER ST APT 5
PASADENA CA
91103-4115
US

V. Phone/Fax

Practice location:
  • Phone: 626-689-6536
  • Fax:
Mailing address:
  • Phone: 626-689-6536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number100802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: