Healthcare Provider Details

I. General information

NPI: 1871235283
Provider Name (Legal Business Name): CRYSTAL ANN BARAJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 MONTANA AVE
EL PASO TX
79925-2155
US

IV. Provider business mailing address

6601 MONTANA AVE STE H
EL PASO TX
79925-2143
US

V. Phone/Fax

Practice location:
  • Phone: 915-838-7604
  • Fax: 866-218-8230
Mailing address:
  • Phone: 915-838-7604
  • Fax: 866-218-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number41947
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: