Provider Demographics
NPI:1831494368
Name:BARAJAS, HECTOR (FNP)
Entity Type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:
Last Name:BARAJAS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88775 76TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:THERMAL
Mailing Address - State:CA
Mailing Address - Zip Code:92274-9681
Mailing Address - Country:US
Mailing Address - Phone:619-398-2405
Mailing Address - Fax:619-398-2412
Practice Address - Street 1:88775 76TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:THERMAL
Practice Address - State:CA
Practice Address - Zip Code:92274-9681
Practice Address - Country:US
Practice Address - Phone:619-398-2405
Practice Address - Fax:619-398-2412
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily