Healthcare Provider Details

I. General information

NPI: 1245756576
Provider Name (Legal Business Name): BARROSO MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5803 NW 151ST ST STE 102-103
MIAMI LAKES FL
33014-2495
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:
Mailing address:
  • Phone: 305-613-7986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IHOSVANI BARROSO
Title or Position: PRESIDENT
Credential: MD
Phone: 786-899-0119