Provider Demographics
NPI:1295704260
Name:BARRETO, SISSI MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:SISSI
Middle Name:MICHELLE
Last Name:BARRETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CALLE RIO SABANA
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-2546
Mailing Address - Country:US
Mailing Address - Phone:787-378-0550
Mailing Address - Fax:787-889-3355
Practice Address - Street 1:J5 CALLE DRA IRMA I RUIZ PAGAN
Practice Address - Street 2:STE 103
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-3400
Practice Address - Country:US
Practice Address - Phone:787-889-3355
Practice Address - Fax:787-889-3355
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13518207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0020566Medicare ID - Type Unspecified
H36535Medicare UPIN