Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 13518 | PR |
NPI | 1295704260 |
---|---|
Provider Name | Sissi Michelle Barreto |
First Address | Luquillo, PR 00773-2546 |
Second Address | Luquillo, PR 00773-3400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 17/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H36535 | (02) |