Provider Demographics
NPI:1932236601
Name:BARRETO, CONCEPCION (MD)
Entity Type:Individual
Prefix:DR
First Name:CONCEPCION
Middle Name:
Last Name:BARRETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CONCEPCION
Other - Middle Name:
Other - Last Name:BARRETO-CUEVAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1178 PINEAPPLE WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6705
Mailing Address - Country:US
Mailing Address - Phone:787-567-7805
Mailing Address - Fax:
Practice Address - Street 1:201 RUBY AVE STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5698
Practice Address - Country:US
Practice Address - Phone:407-933-1847
Practice Address - Fax:407-933-1849
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7932208D00000X, 251S00000X, 261QM0801X, 2083X0100X
FLACN738208D00000X, 251S00000X, 261QM0801X
FL7932251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN738OtherMEDICAL LICENSE
PR7932OtherMEDICAL STATE LICENSE