Provider Demographics
NPI:1790228328
Name:BARAJAS, ADINA (LVN)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:
Last Name:BARAJAS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 S BASCOM AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2651
Mailing Address - Country:US
Mailing Address - Phone:408-793-5959
Mailing Address - Fax:
Practice Address - Street 1:828 S BASCOM AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2652
Practice Address - Country:US
Practice Address - Phone:408-796-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN271866164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse