Provider Demographics
NPI:1235783507
Name:BARAWID, EDWIN O
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:O
Last Name:BARAWID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 PIEDMONT AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1372
Mailing Address - Country:US
Mailing Address - Phone:323-807-5369
Mailing Address - Fax:
Practice Address - Street 1:2745 PIEDMONT AVE APT 105
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1372
Practice Address - Country:US
Practice Address - Phone:323-807-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst