Provider Demographics
NPI:1629406012
Name:BARRAGAN, LONGINO
Entity Type:Individual
Prefix:
First Name:LONGINO
Middle Name:
Last Name:BARRAGAN
Suffix:
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 1:609 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2526
Mailing Address - Country:US
Mailing Address - Phone:818-261-8532
Mailing Address - Fax:
Practice Address - Street 1:609 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2526
Practice Address - Country:US
Practice Address - Phone:818-261-8532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program