Provider Demographics
NPI:1982044004
Name:BARRAZA, ROSA ANA
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:ANA
Last Name:BARRAZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E GILBERT ST
Mailing Address - Street 2:COTTAGE #4
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0911
Mailing Address - Country:US
Mailing Address - Phone:909-387-7024
Mailing Address - Fax:
Practice Address - Street 1:231 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6038
Practice Address - Country:US
Practice Address - Phone:208-713-3752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health