MEDICARE: MARISSA NICOLE 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	106H00000X	Marriage & Family Therapist	158576	CA

General Provider Information

NPI Number	:	1750968756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA NICOLE BARAJAS

Provider Business Mailing Address
First Line	:	8424 GLIDER AVE
Second Line	:
City	:	WESTCHESTER
State	:	CA
Zip	:	90045-4221
Country	:	US
Telephone Number	:	909-996-6362
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 PACIFIC COAST HWY STE 106
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2734
Country	:	US
Telephone Number	:	424-209-2095
Fax Number	:

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

Provider Enumeration Date	:	03/25/2021
Last Update Date	:	10/07/2025

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