Provider Demographics
NPI:1104450261
Name:BARRAGUN, ANGELENA NELLIE
Entity type:Individual
Prefix:
First Name:ANGELENA
Middle Name:NELLIE
Last Name:BARRAGUN
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 1:703 ALLEGHENY ST UNIT 13
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-5752
Mailing Address - Country:US
Mailing Address - Phone:909-255-5838
Mailing Address - Fax:
Practice Address - Street 1:60 N HIGHLAND SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3048
Practice Address - Country:US
Practice Address - Phone:951-845-5984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA162363183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician