Provider Demographics
NPI:1154701670
Name:BARRAZUETA, GUSTAVO (MD)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:BARRAZUETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2402 W PIERCE ST STE 6E
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3566
Mailing Address - Country:US
Mailing Address - Phone:575-628-0312
Mailing Address - Fax:
Practice Address - Street 1:2402 W PIERCE ST STE 6E
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3566
Practice Address - Country:US
Practice Address - Phone:575-628-0312
Practice Address - Fax:575-628-8015
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA264108207X00000X
OH35.142413207X00000X
NMMD2024-0466207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery