Healthcare Provider Details

I. General information

NPI: 1912709593
Provider Name (Legal Business Name): JESSICA ANDREA BARRAZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 HEALTH CENTER DR
SAN DIEGO CA
92123-2773
US

IV. Provider business mailing address

3783 LOGAN AVE
SAN DIEGO CA
92113-2841
US

V. Phone/Fax

Practice location:
  • Phone: 858-637-7888
  • Fax:
Mailing address:
  • Phone: 619-871-0956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number845320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: