Provider Demographics
NPI:1871331124
Name:BARRAZA, RYAN C
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:C
Last Name:BARRAZA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:C
Other - Last Name:KIMMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1350 BRANSON AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5364
Mailing Address - Country:US
Mailing Address - Phone:575-574-2928
Mailing Address - Fax:
Practice Address - Street 1:1350 BRANSON AVE APT 12
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5364
Practice Address - Country:US
Practice Address - Phone:575-574-2928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor