Provider Demographics
NPI:1306559562
Name:BARAJAS, ENRIQUE FRANCISCO JR (LVN729593)
Entity type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:FRANCISCO
Last Name:BARAJAS
Suffix:JR
Gender:M
Credentials:LVN729593
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N PALM CANYON DR # A1-A4
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-1868
Mailing Address - Country:US
Mailing Address - Phone:760-424-5602
Mailing Address - Fax:
Practice Address - Street 1:2500 N PALM CANYON DR # A1-A4
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-1868
Practice Address - Country:US
Practice Address - Phone:760-424-5602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN729593164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse