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General NPI Number Information
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NPI Number | 1538466917
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Entity Type | Organization
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Legal Business Name | JOSE A. BERRIOS, MD PA
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Dates
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Enumeration Date | 02/19/2011
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 320 OAKFIELD DR SUITE D
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City | BRANDON
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State | FL
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Zip | 33511-5723
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Country | US
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Telephone | 813-684-0949
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Fax | 813-654-7105
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Provider Business Mailing Address
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Address Line | PO BOX 105
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City | VALRICO
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State | FL
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Zip | 33595-0105
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Country | US
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Telephone | 813-684-0949
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Fax | 813-654-7105
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE A BERRIOS
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Credential | MD
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Telephone | 813-684-0949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME25337
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License Number State | FL
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