Provider Demographics
NPI:1326589979
Name:BARRAZA SANCHEZ, GUSTAVO
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:BARRAZA SANCHEZ
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 1:4305 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1645
Mailing Address - Country:US
Mailing Address - Phone:760-554-3185
Mailing Address - Fax:
Practice Address - Street 1:4305 UNIVERSITY AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1645
Practice Address - Country:US
Practice Address - Phone:760-554-3185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst