Provider Demographics
NPI:1407618481
Name:BARRAZA, MARISOL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:BARRAZA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HUTTON CENTRE DR STE 950
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-8714
Mailing Address - Country:US
Mailing Address - Phone:855-434-7763
Mailing Address - Fax:
Practice Address - Street 1:5 HUTTON CENTRE DR STE 950
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-8714
Practice Address - Country:US
Practice Address - Phone:855-434-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95066009363LP0808X
CA2024074006363LP0808X
CA95070516390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health