Basic Information
| Provider Information | |||||||||
| NPI: | 1851539555 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARAJAS | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3048 HIGHVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | ALTADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910014812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263720658 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6736 LAUREL CANYON BLVD | ||||||||
| Address2: | SUITE:200 | ||||||||
| City: | N HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916061538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187558786 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2009 | ||||||||
| LastUpdateDate: | 02/03/2009 | ||||||||
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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 | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.