MEDICARE: FERNANDO BARRETO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	26336	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649491093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO BARRETO D.D.S.

Provider Business Mailing Address
First Line	:	1612 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-4227
Country	:	US
Telephone Number	:	213-250-3767
Fax Number	:	213-250-7663

Provider Business Practice Location Address
First Line	:	1612 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-4227
Country	:	US
Telephone Number	:	213-250-3767
Fax Number	:	213-250-7663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/09/2007

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