Provider Demographics
NPI:1821518473
Name:BARRAZA, HECTOR
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:BARRAZA
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 1:523 ROOT RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-0305
Mailing Address - Country:US
Mailing Address - Phone:209-380-8760
Mailing Address - Fax:
Practice Address - Street 1:2600 BERT CRANE RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-9557
Practice Address - Country:US
Practice Address - Phone:209-380-8760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-25
Last Update Date:2017-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA017847343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)