Provider Demographics
NPI:1275317778
Name:BARLETTA FARIAS, ROBERTO CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CARLOS
Last Name:BARLETTA FARIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 SPURWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8803
Mailing Address - Country:US
Mailing Address - Phone:929-330-1733
Mailing Address - Fax:
Practice Address - Street 1:CALLE 30 SE ESQ CALLE 23 CAPAR
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:929-330-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16793208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice