Provider Demographics
NPI:1033183686
Name:LABARBERA, LOUIS MARK (CRNA)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:MARK
Last Name:LABARBERA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 S MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4204
Mailing Address - Country:US
Mailing Address - Phone:305-854-0302
Mailing Address - Fax:305-854-0308
Practice Address - Street 1:3601 W COMMERCIAL BLVD
Practice Address - Street 2:STE 5
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3300
Practice Address - Country:US
Practice Address - Phone:305-485-5666
Practice Address - Fax:954-484-1651
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2739102367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00955275OtherMEDICARE RAILROAD
FL018963200Medicaid
FLG2515WMedicare PIN
FLP00955275OtherMEDICARE RAILROAD