Provider Demographics
NPI:1679538854
Name:BARRUECO-CASARIEGO, MARIA D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:D
Last Name:BARRUECO-CASARIEGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:D
Other - Last Name:BARRUECO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-728-8080
Mailing Address - Fax:954-779-1957
Practice Address - Street 1:1401 SOUTH FEDERAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2619
Practice Address - Country:US
Practice Address - Phone:954-728-8080
Practice Address - Fax:954-779-1957
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074732222Q00000X, 208000000X
FLME74732208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811438200Medicaid
FL253506800Medicaid
FL253506800Medicaid
FL811438200Medicaid