Provider Demographics
NPI:1942844055
Name:ALVAREZ BARAJAS, CECILIA (PA)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:ALVAREZ BARAJAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:707-521-7750
Mailing Address - Fax:707-573-5427
Practice Address - Street 1:3883 AIRWAY DR STE 220
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1671
Practice Address - Country:US
Practice Address - Phone:707-521-7750
Practice Address - Fax:707-573-5427
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1180184363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA59046OtherSTATE MEDICAL LICENSE