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General NPI Number Information
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NPI Number | 1871705004
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Entity Type | Individual
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Provider Name | MARCO BARAHONA P.A
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 4762 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-3026
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Country | US
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Telephone | 323-269-4060
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Fax | 323-269-5284
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Provider Business Mailing Address
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Address Line | 17731 SEMINOLE WAY
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City | YORBA LINDA
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State | CA
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Zip | 92886-5153
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Country | US
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Telephone | 714-993-9433
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Fax | 714-993-9232
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA11840
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 11840
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License Number State | CA
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