Provider Demographics
NPI:1407635519
Name:BARRAZA, CLARISSA RAE
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:RAE
Last Name:BARRAZA
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 1:1249 S MONTEBELLO BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-6447
Mailing Address - Country:US
Mailing Address - Phone:323-313-7954
Mailing Address - Fax:
Practice Address - Street 1:1249 S MONTEBELLO BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-6447
Practice Address - Country:US
Practice Address - Phone:323-313-7954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst