Healthcare Provider Details

I. General information

NPI: 1922562602
Provider Name (Legal Business Name): CHRISTINE MARIE BARROS VEGUILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2019
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 GREENE AVE
BROOKLYN NY
11237-4901
US

IV. Provider business mailing address

PO BOX 367442
SAN JUAN PR
00936-7442
US

V. Phone/Fax

Practice location:
  • Phone: 347-569-6006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number336577
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: