Provider Demographics
NPI:1104971233
Name:DEBARROS, DANIEL M (LAC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:DEBARROS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:DIABETIC
Other - Middle Name:
Other - Last Name:SOLUTIONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DME
Mailing Address - Street 1:3243 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-1537
Mailing Address - Country:US
Mailing Address - Phone:202-905-3077
Mailing Address - Fax:706-896-1050
Practice Address - Street 1:4933 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2631
Practice Address - Country:US
Practice Address - Phone:202-905-3077
Practice Address - Fax:706-896-1050
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00160171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist