Provider Demographics
NPI:1104426980
Name:BARRAGAN, MYRIAM ALODIA (CMI)
Entity type:Individual
Prefix:MISS
First Name:MYRIAM
Middle Name:ALODIA
Last Name:BARRAGAN
Suffix:
Gender:F
Credentials:CMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18352 KESWICK ST UNIT 9
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2082
Mailing Address - Country:US
Mailing Address - Phone:818-281-9107
Mailing Address - Fax:
Practice Address - Street 1:18352 KESWICK ST UNIT 9
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2082
Practice Address - Country:US
Practice Address - Phone:818-281-9107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100525171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter