Provider Demographics
NPI:1962051524
Name:PARRA, KARLA BERENICE
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:BERENICE
Last Name:PARRA
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 1:1075 W HOLT AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3120
Mailing Address - Country:US
Mailing Address - Phone:760-997-0712
Mailing Address - Fax:
Practice Address - Street 1:1075 W HOLT AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3120
Practice Address - Country:US
Practice Address - Phone:760-997-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician