Healthcare Provider Details

I. General information

NPI: 1013976638
Provider Name (Legal Business Name): ANGELIQUE BARRETO M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3418 NW 135TH ST
OKLAHOMA CITY OK
73120-4009
US

IV. Provider business mailing address

3418 NW 135TH ST
OKLAHOMA CITY OK
73120-4009
US

V. Phone/Fax

Practice location:
  • Phone: 405-286-1075
  • Fax: 405-608-1075
Mailing address:
  • Phone: 405-286-1075
  • Fax: 405-608-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELIQUE BARRETO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-286-1075