Individual
ELIECER BARRUETA LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
57 TOWN CT STE 218, PALM COAST, FL 32164-2425
(386) 368-8531
Mailing address
1768 RICHARD LN, WEST PALM BEACH, FL 33406-6576
(561) 319-5157
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ACN1619
FL
208D00000X
General Practice Physician
Primary
23236
PR
390200000X
Student in an Organized Health Care Education/Training Program
15058-I
PR
Other
Enumeration date
05/22/2019
Last updated
01/24/2025
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