Healthcare Provider Details

I. General information

NPI: 1649564014
Provider Name (Legal Business Name): HECTOR BARREZUETA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 WOODWAY DR SUITE 230
WACO TX
76712-6111
US

IV. Provider business mailing address

PO BOX 18962
BELFAST ME
04915-4084
US

V. Phone/Fax

Practice location:
  • Phone: 254-537-6400
  • Fax: 254-537-6401
Mailing address:
  • Phone: 800-566-5050
  • Fax: 254-537-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ1568
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: