Healthcare Provider Details

I. General information

NPI: 1154414258
Provider Name (Legal Business Name): CARLOS ORLANDO BARBOSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N COMMERCE PKWY STE 205
WESTON FL
33326-3206
US

IV. Provider business mailing address

1625 N COMMERCE PKWY STE 205
WESTON FL
33326-3206
US

V. Phone/Fax

Practice location:
  • Phone: 954-659-8550
  • Fax:
Mailing address:
  • Phone: 954-659-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME83660
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberME83660
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: