Provider Demographics
NPI:1164014437
Name:BARNETT, RICARDO ALBERTO
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:ALBERTO
Last Name:BARNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 GLEN ELLEN BAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1757
Mailing Address - Country:US
Mailing Address - Phone:210-316-4836
Mailing Address - Fax:
Practice Address - Street 1:7219 GLEN ELLEN BAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1757
Practice Address - Country:US
Practice Address - Phone:210-316-4836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2184916225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist