Provider Demographics
NPI:1992248553
Name:BARAHONA, MAYRA NOHEMY (SLP)
Entity type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:NOHEMY
Last Name:BARAHONA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33800 CHAPMAN HEIGHTS RD
Mailing Address - Street 2:523
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-3467
Mailing Address - Country:US
Mailing Address - Phone:909-997-0338
Mailing Address - Fax:
Practice Address - Street 1:33800 CHAPMAN HEIGHTS RD
Practice Address - Street 2:523
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-3467
Practice Address - Country:US
Practice Address - Phone:909-997-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20657235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist