Provider Demographics
NPI:1023404720
Name:ANGELIQUE BARRETO MD PLLC
Entity type:Organization
Organization Name:ANGELIQUE BARRETO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-760-3363
Mailing Address - Street 1:3724 EXECUTIVE CENTER DRIVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-956-1210
Mailing Address - Fax:
Practice Address - Street 1:3724 EXECUTIVE CENTER DRIVE
Practice Address - Street 2:SUITE 150
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-956-1210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty