Provider Demographics
NPI:1851954952
Name:BARANDIA, MUHSIN GERMAR JUMAWAN
Entity Type:Individual
Prefix:
First Name:MUHSIN GERMAR
Middle Name:JUMAWAN
Last Name:BARANDIA
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 1:1215 ROLEEN DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-1525
Mailing Address - Country:US
Mailing Address - Phone:707-567-9284
Mailing Address - Fax:
Practice Address - Street 1:744 EMPIRE ST STE 160
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5562
Practice Address - Country:US
Practice Address - Phone:707-399-9413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician