MEDICARE: MARILYN MARIE BARAJAS

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
1	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1598621682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN MARIE BARAJAS

Provider Business Mailing Address
First Line	:	8929 CHANTRY AVE
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92335-4610
Country	:	US
Telephone Number	:	909-637-6318
Fax Number	:	909-637-6318

Provider Business Practice Location Address
First Line	:	8929 CHANTRY AVE
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92335-4610
Country	:	US
Telephone Number	:	909-637-6318
Fax Number	:	909-637-6318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2026
Last Update Date	:	01/01/2026

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