Provider Demographics
NPI:1477227254
Name:BARRERAS, MICHAEL (RDN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BARRERAS
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LITTLE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-9004
Mailing Address - Country:US
Mailing Address - Phone:919-920-4207
Mailing Address - Fax:
Practice Address - Street 1:208 COX BLVD STE 102
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9414
Practice Address - Country:US
Practice Address - Phone:919-731-6018
Practice Address - Fax:919-580-7010
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001091133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered