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NPI Code Detail

MEDICARE: MICHAEL BARRAZA

MEDICARE: MICHAEL BARRAZA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2103TC0700XClinical PsychologistPSY 23994CA

General Provider Information

NPI Number : 1174641302
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL BARRAZA
Provider Business Mailing Address
First Line : 4060 WATSON PLAZA DR
Second Line :
City : LAKEWOOD
State : CA
Zip : 90712-4033
Country : US
Telephone Number : 562-420-6325
Fax Number :
Provider Business Practice Location Address
First Line : 4060 WATSON PLAZA DR
Second Line :
City : LAKEWOOD
State : CA
Zip : 90712-4033
Country : US
Telephone Number : 562-420-6325
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2007
Last Update Date : 06/13/2012

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Directions to “ MICHAEL BARRAZA ” Practice Location

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