Healthcare Provider Details

I. General information

NPI: 1285552562
Provider Name (Legal Business Name): YVONNE BARRAZA CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YVONNE PADILLA CMT

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 SAINT MARKS PLZ STE C3
STOCKTON CA
95207-6410
US

IV. Provider business mailing address

3435 MICHIGAN AVE
STOCKTON CA
95204-3824
US

V. Phone/Fax

Practice location:
  • Phone: 209-589-8439
  • Fax:
Mailing address:
  • Phone: 209-589-8439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number52117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: