Provider Demographics
NPI:1588763130
Name:BARRERA, RODOLFO CANTU (DO)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:CANTU
Last Name:BARRERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 E 32ND ST
Mailing Address - Street 2:203
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2707
Mailing Address - Country:US
Mailing Address - Phone:512-476-5437
Mailing Address - Fax:512-476-0960
Practice Address - Street 1:1015 E 32ND ST
Practice Address - Street 2:203
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2707
Practice Address - Country:US
Practice Address - Phone:512-476-5437
Practice Address - Fax:512-476-0960
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3737208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132873403Medicaid
TX132873408Medicaid
TX132873408Medicaid
E80984Medicare UPIN