Healthcare Provider Details

I. General information

NPI: 1710466651
Provider Name (Legal Business Name): LUIS JORGE RICARDO BARRERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NW 36TH ST
MIAMI FL
33142-5559
US

IV. Provider business mailing address

16451 SW 45TH ST
MIAMI FL
33185-3896
US

V. Phone/Fax

Practice location:
  • Phone: 786-378-8200
  • Fax: 305-907-5871
Mailing address:
  • Phone: 786-208-7904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9264405
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: