Provider Demographics
NPI:1720689292
Name:HERNANDEZ BARRETO, IDILEIMY NANETTE (DC)
Entity type:Individual
Prefix:DR
First Name:IDILEIMY
Middle Name:NANETTE
Last Name:HERNANDEZ BARRETO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 PALOMA DR STE 110
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-2211
Mailing Address - Country:US
Mailing Address - Phone:254-598-2677
Mailing Address - Fax:
Practice Address - Street 1:204 PALOMA DR STE 110
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2211
Practice Address - Country:US
Practice Address - Phone:254-598-2677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor