Provider Demographics
NPI:1154030021
Name:BARAJAS GONZALEZ, ANNIA C
Entity type:Individual
Prefix:MRS
First Name:ANNIA
Middle Name:C
Last Name:BARAJAS GONZALEZ
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 1:1715 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-4545
Mailing Address - Country:US
Mailing Address - Phone:253-241-5798
Mailing Address - Fax:
Practice Address - Street 1:1715 E 46TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-4545
Practice Address - Country:US
Practice Address - Phone:253-241-5798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604500689171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter