Provider Demographics
NPI:1407452881
Name:BARRAGAN-VEGA, CRISTAL NADINE
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:NADINE
Last Name:BARRAGAN-VEGA
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 1:4146 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3140
Mailing Address - Country:US
Mailing Address - Phone:263-538-9336
Mailing Address - Fax:626-602-3875
Practice Address - Street 1:4146 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3140
Practice Address - Country:US
Practice Address - Phone:626-353-8933
Practice Address - Fax:626-602-3875
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician