Provider Demographics
NPI:1508026568
Name:BERRIOS ROSADO, CARLOS RUBEN (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:RUBEN
Last Name:BERRIOS ROSADO
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-8226
Mailing Address - Fax:
Practice Address - Street 1:730 MALABAR RD
Practice Address - Street 2:
Practice Address - City:MALABAR
Practice Address - State:FL
Practice Address - Zip Code:32950-3140
Practice Address - Country:US
Practice Address - Phone:321-434-8226
Practice Address - Fax:321-434-8227
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1441942084N0400X
PR187332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105745900Medicaid
FLMA532OtherMEDICARE