Provider Demographics
NPI:1548387996
Name:BARROSO-VICENS, ELVIRA (MD)
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:
Last Name:BARROSO-VICENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SIGNATURE TER
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-5415
Mailing Address - Country:US
Mailing Address - Phone:727-799-7240
Mailing Address - Fax:
Practice Address - Street 1:5610 W LA SALLE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1770
Practice Address - Country:US
Practice Address - Phone:813-289-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63776207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology