Provider Demographics
NPI:1558909028
Name:BARBA, RAPHAEL PRADO JR
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:PRADO
Last Name:BARBA
Suffix:JR
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 1:3522 SANTIAGO CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-9534
Mailing Address - Country:US
Mailing Address - Phone:209-455-2073
Mailing Address - Fax:
Practice Address - Street 1:1301 YOSEMITE PKWY
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-5203
Practice Address - Country:US
Practice Address - Phone:209-722-6335
Practice Address - Fax:209-722-6371
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)