Provider Demographics
NPI:1104196898
Name:BARRAZA, MARK A (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:BARRAZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11351 BARTEE AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25201 AVENUE TIBBITTS
Practice Address - Street 2:SUITE 101
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3433
Practice Address - Country:US
Practice Address - Phone:818-282-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor