Provider Demographics
NPI:1699863118
Name:BARROSO, JUAN (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:BARROSO
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 1:1435 W 49TH PL
Mailing Address - Street 2:SUITE 603
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3197
Mailing Address - Country:US
Mailing Address - Phone:305-556-1699
Mailing Address - Fax:305-556-6610
Practice Address - Street 1:1435 W 49TH PL
Practice Address - Street 2:SUITE 603
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3197
Practice Address - Country:US
Practice Address - Phone:305-556-1699
Practice Address - Fax:305-556-6610
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042579207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069533500Medicaid
FL96264Medicare ID - Type Unspecified