1295704260 NPI number — SISSI MICHELLE BARRETO MD

Table of content: SISSI MICHELLE BARRETO MD (NPI 1295704260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295704260 NPI number — SISSI MICHELLE BARRETO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRETO
Provider First Name:
SISSI
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295704260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 CALLE RIO SABANA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUQUILLO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00773-2546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-378-0550
Provider Business Mailing Address Fax Number:
787-889-3355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
J5 CALLE DRA IRMA I RUIZ PAGAN
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
LUQUILLO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00773-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-889-3355
Provider Business Practice Location Address Fax Number:
787-889-3355
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X , with the licence number:  13518 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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