Provider Demographics
NPI:1477566784
Name:BARRETO, LUIS L (PA)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:L
Last Name:BARRETO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 W END AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1378
Mailing Address - Country:US
Mailing Address - Phone:800-348-4565
Mailing Address - Fax:888-468-6511
Practice Address - Street 1:1600 SARNO RD STE 15
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4990
Practice Address - Country:US
Practice Address - Phone:800-348-4565
Practice Address - Fax:888-468-6511
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2903363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291262700Medicaid
FLE7935ZMedicare ID - Type Unspecified
FL291262700Medicaid