Provider Demographics
NPI:1104595784
Name:BARAJAS, NORMA R
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:R
Last Name:BARAJAS
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 1:904 LARSEN LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-4352
Mailing Address - Country:US
Mailing Address - Phone:209-505-7969
Mailing Address - Fax:
Practice Address - Street 1:1830 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2163
Practice Address - Country:US
Practice Address - Phone:209-538-4927
Practice Address - Fax:209-538-6991
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72406183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician