Provider Demographics
NPI:1104254267
Name:ESPINO BARAJAS, WENDY JANETT
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:JANETT
Last Name:ESPINO BARAJAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:BARAJAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1411 W 190TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4325
Mailing Address - Country:US
Mailing Address - Phone:323-690-4035
Mailing Address - Fax:
Practice Address - Street 1:1411 W 190TH ST STE 300
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4325
Practice Address - Country:US
Practice Address - Phone:323-690-4035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist