Healthcare Provider Details

I. General information

NPI: 1669825584
Provider Name (Legal Business Name): STEPHANY BARRETO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 NE MEDICAL CENTER DR
BEND OR
97701-6061
US

IV. Provider business mailing address

1460 NE MEDICAL CENTER DR
BEND OR
97701-6061
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-6633
  • Fax:
Mailing address:
  • Phone: 541-382-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP03815
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD219150
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA171040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: