Healthcare Provider Details

I. General information

NPI: 1477552941
Provider Name (Legal Business Name): ROBERTO LIMGENCO BARRETTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE STE. 311
ORANGE CA
92868-4203
US

IV. Provider business mailing address

2412 N HIGHWOOD RD
ORANGE CA
92867-6479
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-4020
  • Fax: 714-633-4846
Mailing address:
  • Phone: 714-633-4020
  • Fax: 714-633-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberA81316
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA81316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: