Healthcare Provider Details

I. General information

NPI: 1538779830
Provider Name (Legal Business Name): ELIZABETH GUADALUPE BARRAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 UNIVERSITY AVE STE 108
SACRAMENTO CA
95825-6726
US

IV. Provider business mailing address

650 UNIVERSITY AVE STE 108
SACRAMENTO CA
95825-6726
US

V. Phone/Fax

Practice location:
  • Phone: 916-646-2471
  • Fax: 916-646-2472
Mailing address:
  • Phone: 916-646-2471
  • Fax: 916-646-2472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA8586
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU3577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: