Provider Demographics
NPI:1952059966
Name:BARAJAS, GABRIEL ANGEL
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ANGEL
Last Name:BARAJAS
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 1:751 N LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4634
Mailing Address - Country:US
Mailing Address - Phone:909-503-6580
Mailing Address - Fax:
Practice Address - Street 1:751 N LINDEN AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4634
Practice Address - Country:US
Practice Address - Phone:909-503-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9151014609OtherLOMA LINDA