Provider Demographics
NPI:1881829356
Name:BARAJAS, MARICRUZ (BA)
Entity Type:Individual
Prefix:MISS
First Name:MARICRUZ
Middle Name:
Last Name:BARAJAS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MELBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4428
Mailing Address - Country:US
Mailing Address - Phone:208-403-8371
Mailing Address - Fax:
Practice Address - Street 1:250 MELBOURNE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4428
Practice Address - Country:US
Practice Address - Phone:208-403-8371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker