Healthcare Provider Details

I. General information

NPI: 1831494368
Provider Name (Legal Business Name): HECTOR BARAJAS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88775 76TH AVE SUITE 1
THERMAL CA
92274-9681
US

IV. Provider business mailing address

88775 76TH AVE SUITE 1
THERMAL CA
92274-9681
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-2405
  • Fax: 619-398-2412
Mailing address:
  • Phone: 619-398-2405
  • Fax: 619-398-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: