Provider Demographics
NPI:1477731222
Name:CARLOS BARAHONA
Entity Type:Organization
Organization Name:CARLOS BARAHONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE PROVIDER 3
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAHONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-457-1925
Mailing Address - Street 1:914 MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-6106
Mailing Address - Country:US
Mailing Address - Phone:415-457-1925
Mailing Address - Fax:415-457-1929
Practice Address - Street 1:914 MISSION AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-6106
Practice Address - Country:US
Practice Address - Phone:415-457-1925
Practice Address - Fax:415-457-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health