Provider Demographics
NPI:1225037054
Name:BARZAGA, GRACIELA ABERION (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACIELA
Middle Name:ABERION
Last Name:BARZAGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 N CALIFORNIA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5500
Mailing Address - Country:US
Mailing Address - Phone:209-465-7463
Mailing Address - Fax:209-465-0182
Practice Address - Street 1:2626 N CALIFORNIA ST
Practice Address - Street 2:SUITE C
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5500
Practice Address - Country:US
Practice Address - Phone:209-465-7463
Practice Address - Fax:209-465-0182
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30287208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A302870Medicaid
A87338Medicare UPIN
CA00A302870Medicaid