Provider Demographics
NPI:1316904097
Name:BARRERA, GILBERT RUIZ JR (IDC)
Entity type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:RUIZ
Last Name:BARRERA
Suffix:JR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314A SMITH LN
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2538
Mailing Address - Country:US
Mailing Address - Phone:949-361-1127
Mailing Address - Fax:
Practice Address - Street 1:314A SMITH LN
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-2538
Practice Address - Country:US
Practice Address - Phone:949-361-1127
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman