Provider Demographics
NPI:1205895133
Name:BARAHONA, JOAQUIN A (M D)
Entity type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:A
Last Name:BARAHONA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 CESAR CHAVEZ
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4628
Mailing Address - Country:US
Mailing Address - Phone:415-826-7575
Mailing Address - Fax:415-826-3014
Practice Address - Street 1:3260 CESAR CHAVEZ
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4628
Practice Address - Country:US
Practice Address - Phone:415-826-7575
Practice Address - Fax:415-826-3014
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ20708ZMedicaid
CA00G610840Medicare ID - Type Unspecified
CAE65339Medicare UPIN