Provider Demographics
NPI:1992918742
Name:BARANZINI, GARY WAYNE (LAC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:WAYNE
Last Name:BARANZINI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1770 N TRACY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-2428
Mailing Address - Country:US
Mailing Address - Phone:209-879-9764
Mailing Address - Fax:866-929-4101
Practice Address - Street 1:1770 N TRACY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2428
Practice Address - Country:US
Practice Address - Phone:209-879-9764
Practice Address - Fax:866-929-4101
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11545171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist