Healthcare Provider Details

I. General information

NPI: 1336727528
Provider Name (Legal Business Name): CARLOS MISAEL BARRERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7135 SW 117TH AVE
MIAMI FL
33183-2802
US

IV. Provider business mailing address

7135 SW 117TH AVE
MIAMI FL
33183-2802
US

V. Phone/Fax

Practice location:
  • Phone: 844-665-4827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME158004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: