Basic Information
| Provider Information | |||||||||
| NPI: | 1831674787 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARRAZA | ||||||||
| FirstName: | FERNANDO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15858 FELLOWSHIP ST | ||||||||
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| City: | LA PUENTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917441223 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 13651 WILLARD ST | ||||||||
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| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183752000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2018 | ||||||||
| LastUpdateDate: | 09/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227900000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered |
No ID Information.