Provider Demographics
NPI:1962789206
Name:PARRA, JOAQUIN JR
Entity type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:
Last Name:PARRA
Suffix:JR
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 1:1908 SENTER RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2629
Mailing Address - Country:US
Mailing Address - Phone:408-200-0980
Mailing Address - Fax:
Practice Address - Street 1:1908 SENTER RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2629
Practice Address - Country:US
Practice Address - Phone:408-200-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator