Provider Demographics
NPI:1508244146
Name:DE LA BARRERA, MARIO ENRIQUE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:ENRIQUE
Last Name:DE LA BARRERA
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4881 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WRIGHT PATTERSON AFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5529
Mailing Address - Country:US
Mailing Address - Phone:937-713-1237
Mailing Address - Fax:937-656-3700
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5529
Practice Address - Country:US
Practice Address - Phone:937-713-1237
Practice Address - Fax:937-656-3700
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2023-03-15
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant