Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | ME65145 | FL |
NPI | 1508975566 |
---|---|
Provider Name | Hector Delfin Barreto-Samalot |
First Address | Orlando, FL 32806-4944 |
Second Address | Orlando, FL 32806-4944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E57717 | (02) |