Provider Demographics
NPI:1801136411
Name:PARRAGA, AN-TONIA
Entity type:Individual
Prefix:
First Name:AN-TONIA
Middle Name:
Last Name:PARRAGA
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:PO BOX 7711
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92513-7711
Mailing Address - Country:US
Mailing Address - Phone:951-427-9992
Mailing Address - Fax:951-247-6959
Practice Address - Street 1:12810 HEACOCK ST STE B202
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-2873
Practice Address - Country:US
Practice Address - Phone:951-247-6542
Practice Address - Fax:951-247-6959
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87071106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist