Healthcare Provider Details

I. General information

NPI: 1346374469
Provider Name (Legal Business Name): PRISCILLA CHINCHILLA BARAJAS PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13130 BURBANK BLVD
SHERMAN OAKS CA
91401-6037
US

IV. Provider business mailing address

13130 BURBANK BLVD
SHERMAN OAKS CA
91401-6037
US

V. Phone/Fax

Practice location:
  • Phone: 562-233-4243
  • Fax:
Mailing address:
  • Phone: 562-233-4243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22289
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 22289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: