Healthcare Provider Details

I. General information

NPI: 1073447553
Provider Name (Legal Business Name): MARCOS FABIAN GONZALEZ BARRETO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CALLE LAS DELICIAS
ISABELA PR
00662-4216
US

IV. Provider business mailing address

4 CALLE LAS DELICIAS
ISABELA PR
00662-4216
US

V. Phone/Fax

Practice location:
  • Phone: 939-308-1830
  • Fax: 939-308-1830
Mailing address:
  • Phone: 939-308-1830
  • Fax: 939-308-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2919
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: