Provider Demographics
NPI:1346328630
Name:SO FL ORTHOPAEDIC REHABILITATION CONS
Entity Type:Organization
Organization Name:SO FL ORTHOPAEDIC REHABILITATION CONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-448-8464
Mailing Address - Street 1:592 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2906
Mailing Address - Country:US
Mailing Address - Phone:305-448-8464
Mailing Address - Fax:305-444-5456
Practice Address - Street 1:592 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2906
Practice Address - Country:US
Practice Address - Phone:305-448-8464
Practice Address - Fax:305-444-5456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99007AMedicare PIN