Provider Demographics
NPI:1699075085
Name:BERRIOS, CARMELO (MD)
Entity type:Individual
Prefix:DR
First Name:CARMELO
Middle Name:
Last Name:BERRIOS
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 1:8567 CORAL WAY # 367
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:787-438-6598
Mailing Address - Fax:
Practice Address - Street 1:8 CALLE ORION
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3917
Practice Address - Country:US
Practice Address - Phone:787-438-6598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18065172V00000X
FLACN-570172V00000X
FLACN570172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1699075085Medicaid