Healthcare Provider Details

I. General information

NPI: 1639827710
Provider Name (Legal Business Name): LUIS ALBERTO BORROTO BERMUDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 68TH ST
HIALEAH FL
33016-1898
US

IV. Provider business mailing address

2001 W 68TH ST
HIALEAH FL
33016-1898
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-5000
  • Fax:
Mailing address:
  • Phone: 305-823-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME178949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: