Healthcare Provider Details

I. General information

NPI: 1508573668
Provider Name (Legal Business Name): MARIA GUADALUPE BARAJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W THOUSAND OAKS BLVD STE 500
THOUSAND OAKS CA
91360-4462
US

IV. Provider business mailing address

PO BOX 2191
OXNARD CA
93034-2191
US

V. Phone/Fax

Practice location:
  • Phone: 805-777-3516
  • Fax:
Mailing address:
  • Phone: 805-616-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-QESOHK
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: