Provider Demographics
NPI:1548932403
Name:BARAHONA, WILNELIA CAROLINA
Entity type:Individual
Prefix:
First Name:WILNELIA
Middle Name:CAROLINA
Last Name:BARAHONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-4501
Mailing Address - Country:US
Mailing Address - Phone:323-972-0406
Mailing Address - Fax:
Practice Address - Street 1:2675 ARLINGTON AVE APT 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-2513
Practice Address - Country:US
Practice Address - Phone:323-877-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider