Healthcare Provider Details

I. General information

NPI: 1225857543
Provider Name (Legal Business Name): AIMEE MARIE BARAJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MORENA BLVD STE 100
SAN DIEGO CA
92110-3842
US

IV. Provider business mailing address

2067 AVENIDA DEL MEXICO APT 21
SAN DIEGO CA
92154-1264
US

V. Phone/Fax

Practice location:
  • Phone: 619-275-0822
  • Fax:
Mailing address:
  • Phone: 619-289-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: