Provider Demographics
NPI:1871705004
Name:BARAHONA, MARCO (PA)
Entity type:Individual
Prefix:MR
First Name:MARCO
Middle Name:
Last Name:BARAHONA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17731 SEMINOLE WAY
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-5153
Mailing Address - Country:US
Mailing Address - Phone:714-993-9433
Mailing Address - Fax:714-993-9232
Practice Address - Street 1:4762 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-3026
Practice Address - Country:US
Practice Address - Phone:323-269-4060
Practice Address - Fax:323-269-5284
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11840363A00000X
CAPA 11840363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical