Provider Demographics
NPI:1255680377
Name:BARRAGAN HERNANDEZ, CESAR (LMP)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:BARRAGAN HERNANDEZ
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 W CLEARWATER AVE # B
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3100
Mailing Address - Country:US
Mailing Address - Phone:509-374-4719
Mailing Address - Fax:509-374-3873
Practice Address - Street 1:8503 W CLEARWATER AVE # B
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3100
Practice Address - Country:US
Practice Address - Phone:509-374-4719
Practice Address - Fax:509-374-3873
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60264401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist