Provider Demographics
NPI:1710640180
Name:BARAJAS, TAVIANA (PA-C)
Entity Type:Individual
Prefix:
First Name:TAVIANA
Middle Name:
Last Name:BARAJAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 MAGNOLIA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3332
Mailing Address - Country:US
Mailing Address - Phone:909-212-0538
Mailing Address - Fax:
Practice Address - Street 1:341 MAGNOLIA AVE STE 204
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3332
Practice Address - Country:US
Practice Address - Phone:909-212-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant