Provider Demographics
NPI:1952681223
Name:BARROS, ANTONIO (LAC)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:BARROS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 NW VINE ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-8439
Mailing Address - Country:US
Mailing Address - Phone:541-476-5893
Mailing Address - Fax:
Practice Address - Street 1:2160 NW VINE ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-8439
Practice Address - Country:US
Practice Address - Phone:541-476-5893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC153240171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist