Provider Demographics
NPI:1982384723
Name:DE LA BARRA, MARIA AIDEE ERIKA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA AIDEE
Middle Name:ERIKA
Last Name:DE LA BARRA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 4189
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-4189
Mailing Address - Country:US
Mailing Address - Phone:954-363-9582
Mailing Address - Fax:954-363-9663
Practice Address - Street 1:2548 SIMPSON RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4637
Practice Address - Country:US
Practice Address - Phone:407-632-4201
Practice Address - Fax:407-632-4206
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2024-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLACN1611208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL121911900Medicaid