Provider Demographics
NPI:1851563761
Name:BARRAGAN, JORGE A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name:BARRAGAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-9308
Mailing Address - Country:US
Mailing Address - Phone:209-543-3663
Mailing Address - Fax:209-543-3640
Practice Address - Street 1:4643 BROADWAY
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CA
Practice Address - Zip Code:95368-9308
Practice Address - Country:US
Practice Address - Phone:209-543-3663
Practice Address - Fax:209-543-3640
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21889103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical