Provider Demographics
NPI:1255168340
Name:BARRAGAN, ILEANA VERONICA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:VERONICA
Last Name:BARRAGAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9749 LA ALBA DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-1321
Mailing Address - Country:US
Mailing Address - Phone:562-972-6827
Mailing Address - Fax:
Practice Address - Street 1:1515 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3906
Practice Address - Country:US
Practice Address - Phone:714-542-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily