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General NPI Number Information
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NPI Number | 1750968756
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Entity Type | Individual
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Provider Name | MARISSA NICOLE BARAJAS
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Gender | Female
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 2401 PACIFIC COAST HWY STE 106
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2734
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Country | US
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Telephone | 424-209-2095
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Fax |
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Provider Business Mailing Address
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Address Line | 8424 GLIDER AVE
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City | WESTCHESTER
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State | CA
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Zip | 90045-4221
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Country | US
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Telephone | 909-996-6362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 158576
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License Number State | CA
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