Healthcare Provider Details

I. General information

NPI: 1477044386
Provider Name (Legal Business Name): ERICA BARAJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W 11TH ST
TRACY CA
95376-3944
US

IV. Provider business mailing address

1831 CLOVER LN
STOCKTON CA
95206-3515
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-8778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: