Provider Demographics
NPI:1104643337
Name:BARRAGAN, CARLOS ANDRES (CTRS)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ANDRES
Last Name:BARRAGAN
Suffix:
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 LEMITAR WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-2751
Mailing Address - Country:US
Mailing Address - Phone:916-320-8795
Mailing Address - Fax:
Practice Address - Street 1:444 N 3RD ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-0226
Practice Address - Country:US
Practice Address - Phone:833-560-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
62749225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist