Basic Information
| Provider Information | |||||||||
| NPI: | 1154948909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRAZA | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ANDREA | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10050 FOX ST | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925035420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626569531 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3924 RIVERVIEW DR | ||||||||
| Address2: | |||||||||
| City: | JURUPA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925096611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513604175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2020 | ||||||||
| LastUpdateDate: | 06/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | N | Behavioral Health & Social Service Providers | Social Worker | School | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.