Provider Demographics
NPI:1568192136
Name:BARRETO ACEVEDO, OMAR DAVID (NL)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:DAVID
Last Name:BARRETO ACEVEDO
Suffix:
Gender:M
Credentials:NL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:V4 CALLE ONIX
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-6861
Mailing Address - Country:US
Mailing Address - Phone:787-923-9191
Mailing Address - Fax:
Practice Address - Street 1:V4 CALLE ONIX
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-6861
Practice Address - Country:US
Practice Address - Phone:787-923-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR221175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath