Provider Demographics
NPI:1003129545
Name:BARRAZA, ROSALINDA (OTR)
Entity Type:Individual
Prefix:
First Name:ROSALINDA
Middle Name:
Last Name:BARRAZA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 W WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260
Mailing Address - Country:US
Mailing Address - Phone:575-441-0722
Mailing Address - Fax:
Practice Address - Street 1:18 W WASHINGTON
Practice Address - Street 2:
Practice Address - City:LOVINGTON
Practice Address - State:NM
Practice Address - Zip Code:88260
Practice Address - Country:US
Practice Address - Phone:575-441-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2670225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12874281Medicaid