Healthcare Provider Details

I. General information

NPI: 1760466940
Provider Name (Legal Business Name): BERNADETTE BARBOSA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C/11 BLQ 33 #8 VILLA CAROLINA
CAROLINA PR
00985
US

IV. Provider business mailing address

525 CARR 8860 APT. 2647
TRUJILLO ALTO PR
00976-5412
US

V. Phone/Fax

Practice location:
  • Phone: 787-762-3625
  • Fax: 787-701-0859
Mailing address:
  • Phone: 939-640-5556
  • Fax: 787-701-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13792
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: