Provider Demographics
NPI:1245690452
Name:ALBARRACIN, JOHANA (BA DEGREE IN PSYCHOL)
Entity type:Individual
Prefix:
First Name:JOHANA
Middle Name:
Last Name:ALBARRACIN
Suffix:
Gender:F
Credentials:BA DEGREE IN PSYCHOL
Other - Prefix:
Other - First Name:JOHANA
Other - Middle Name:MARIA
Other - Last Name:ALBARRACIN SANCHEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA IN PHSYCHOLOGY
Mailing Address - Street 1:5145 RAWHIDE ST
Mailing Address - Street 2:APT 146
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-4801
Mailing Address - Country:US
Mailing Address - Phone:702-272-3699
Mailing Address - Fax:
Practice Address - Street 1:5145 RAWHIDE ST
Practice Address - Street 2:APT 146
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-4801
Practice Address - Country:US
Practice Address - Phone:702-272-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1704933411Medicaid