Healthcare Provider Details

I. General information

NPI: 1770373227
Provider Name (Legal Business Name): LAURA BARAJAS ALONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 HARRISON ST
RIVERSIDE CA
92503-3523
US

IV. Provider business mailing address

82377 GABLE DR
INDIO CA
92201-7440
US

V. Phone/Fax

Practice location:
  • Phone: 833-391-0505
  • Fax:
Mailing address:
  • Phone: 760-600-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: