Provider Demographics
NPI:1154414258
Name:BARBOSA, CARLOS ORLANDO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ORLANDO
Last Name:BARBOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N COMMERCE PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3206
Mailing Address - Country:US
Mailing Address - Phone:954-659-8550
Mailing Address - Fax:
Practice Address - Street 1:1625 N COMMERCE PKWY STE 205
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3206
Practice Address - Country:US
Practice Address - Phone:954-659-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83660208000000X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266448800Medicaid