Healthcare Provider Details

I. General information

NPI: 1396014726
Provider Name (Legal Business Name): ERNEST BARRAZA CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 VALLEY BLVD
POMONA CA
91768-3325
US

IV. Provider business mailing address

459 W 41ST ST
LOS ANGELES CA
90037-2116
US

V. Phone/Fax

Practice location:
  • Phone: 909-865-2689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: