Healthcare Provider Details

I. General information

NPI: 1992058408
Provider Name (Legal Business Name): IHOSVANI BARROSO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 E 4TH AVE STE B
HIALEAH FL
33013-1814
US

IV. Provider business mailing address

4835 E 4TH AVE STE B
HIALEAH FL
33013-1814
US

V. Phone/Fax

Practice location:
  • Phone: 786-899-0119
  • Fax: 786-899-0440
Mailing address:
  • Phone: 786-899-0119
  • Fax: 786-899-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME1223334
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME122334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: