Provider Demographics
NPI:1710466651
Name:RICARDO BARRERO, LUIS JORGE
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:JORGE
Last Name:RICARDO BARRERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16451 SW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-3896
Mailing Address - Country:US
Mailing Address - Phone:786-208-7904
Mailing Address - Fax:
Practice Address - Street 1:1501 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5559
Practice Address - Country:US
Practice Address - Phone:786-378-8200
Practice Address - Fax:305-907-5871
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9264405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily