Provider Demographics
NPI:1013231521
Name:BARAJAS, ROMANA
Entity Type:Individual
Prefix:
First Name:ROMANA
Middle Name:
Last Name:BARAJAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 ARAGON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-1624
Mailing Address - Country:US
Mailing Address - Phone:323-327-5117
Mailing Address - Fax:
Practice Address - Street 1:5701 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2973
Practice Address - Country:US
Practice Address - Phone:323-837-0838
Practice Address - Fax:323-837-9719
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CAZDFBMOSWJIGXALQE175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner