Provider Demographics
NPI:1023821345
Name:BARRAZA, JUAN ARMANDO
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ARMANDO
Last Name:BARRAZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11508 E SEGURA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-7126
Mailing Address - Country:US
Mailing Address - Phone:480-647-2311
Mailing Address - Fax:
Practice Address - Street 1:2150 S COUNTRY CLUB DR STE 36
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6886
Practice Address - Country:US
Practice Address - Phone:480-527-9128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician