Provider Demographics
NPI:1972672970
Name:BARRIENTOS-GAYOSO, JUAN MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MIGUEL
Last Name:BARRIENTOS-GAYOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 375 PO BOX 5075
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9809
Mailing Address - Country:US
Mailing Address - Phone:787-873-5359
Mailing Address - Fax:787-873-5359
Practice Address - Street 1:22 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-804-0020
Practice Address - Fax:787-804-0020
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR009787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG04553Medicare UPIN
PR83339Medicare ID - Type Unspecified