Healthcare Provider Details

I. General information

NPI: 1467278036
Provider Name (Legal Business Name): DAVID BARRETO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2024
Last Update Date: 11/28/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33-41 NEWARK ST FL 5
HOBOKEN NJ
07030-5627
US

IV. Provider business mailing address

901 EGAN DR
ORLANDO FL
32822-6017
US

V. Phone/Fax

Practice location:
  • Phone: 917-647-1665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: