Provider Demographics
NPI:1720482235
Name:BARELA, STEPHANIE RUTH (CHES)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RUTH
Last Name:BARELA
Suffix:
Gender:F
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:01 SAGEBRUSH ST
Mailing Address - Street 2:PO BOX 640
Mailing Address - City:ISLETA
Mailing Address - State:NM
Mailing Address - Zip Code:87022
Mailing Address - Country:US
Mailing Address - Phone:505-869-4479
Mailing Address - Fax:505-869-4584
Practice Address - Street 1:01 SAGEBRUSH ST
Practice Address - Street 2:
Practice Address - City:ISLETA
Practice Address - State:NM
Practice Address - Zip Code:87022
Practice Address - Country:US
Practice Address - Phone:505-869-4479
Practice Address - Fax:505-869-4584
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator