Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C51628 | CA |
NPI | 1245637289 |
---|---|
Provider Name | Stephanie Barajas I |
First Address | Chico, CA 95926-1991 |
Second Address | Chico, CA 95926-1991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2014 |
Last Update Date | 19/11/2014 |