Healthcare Provider Details

I. General information

NPI: 1386483808
Provider Name (Legal Business Name): RUT BARAJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SPRINGER DR
REDDING CA
96003-4592
US

IV. Provider business mailing address

2411 MARINDA WAY
REDDING CA
96001-3705
US

V. Phone/Fax

Practice location:
  • Phone: 530-224-4140
  • Fax:
Mailing address:
  • Phone: 262-412-8859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number230150102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: