Provider Demographics
NPI:1124790407
Name:BARAJAS, ANTHONY WILLIAM
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:WILLIAM
Last Name:BARAJAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9840 MASTERFUL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4535
Mailing Address - Country:US
Mailing Address - Phone:702-501-2336
Mailing Address - Fax:
Practice Address - Street 1:9840 MASTERFUL DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4535
Practice Address - Country:US
Practice Address - Phone:747-228-6256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider