1639301864 NPI number — AMBER BARRETO

Table of content: AMBER BARRETO (NPI 1639301864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639301864 NPI number — AMBER BARRETO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRETO
Provider First Name:
AMBER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1639301864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3146 LYNNHAVEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELTONA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32738-4225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
917 BEVILLE RD
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
SOUTH DAYTONA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-756-4395
Provider Business Practice Location Address Fax Number:
866-426-2811
Provider Enumeration Date:
08/21/2009

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: 224Z00000X , with the licence number:  3183 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224Z00000X , with the licence number: 11268 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224Z00000X , with the licence number: OTA10322 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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