Healthcare Provider Details

I. General information

NPI: 1124409743
Provider Name (Legal Business Name): JUAN RICARDO BARRON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 SOUTHERN BLVD
LOXAHATCHEE FL
33470-9203
US

IV. Provider business mailing address

13694 IMPERIAL TOPAZ TRL
DELRAY BEACH FL
33446-2242
US

V. Phone/Fax

Practice location:
  • Phone: 787-298-4988
  • Fax:
Mailing address:
  • Phone: 787-298-4988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number21055
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125-067121
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME162598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: