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: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 CALLE SAN JORGE STE 406
SAN JUAN PR
00912-3241
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-0210
  • Fax:
Mailing address:
  • Phone: 305-661-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: