Provider Demographics
NPI:1215259692
Name:BARRAZA, MAURA CONCEPCION
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:CONCEPCION
Last Name:BARRAZA
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:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:BERINO
Mailing Address - State:NM
Mailing Address - Zip Code:88024-0176
Mailing Address - Country:US
Mailing Address - Phone:915-276-9580
Mailing Address - Fax:
Practice Address - Street 1:101 E JOY RD
Practice Address - Street 2:
Practice Address - City:BERINO
Practice Address - State:NM
Practice Address - Zip Code:88024
Practice Address - Country:US
Practice Address - Phone:915-276-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator