Provider Demographics
NPI:1245756576
Name:BARROSO MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:BARROSO MEDICAL SERVICES LLC
Other - Org Name:AB CORE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IHOSVANI
Authorized Official - Middle Name:
Authorized Official - Last Name:BARROSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-899-0119
Mailing Address - Street 1:4835 E 4TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1814
Mailing Address - Country:US
Mailing Address - Phone:305-613-7986
Mailing Address - Fax:
Practice Address - Street 1:4835 E 4TH AVE STE B
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1814
Practice Address - Country:US
Practice Address - Phone:786-899-0119
Practice Address - Fax:786-899-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122334208000000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022004900Medicaid
FLME122334OtherMEDICAL LICENSE