Provider Demographics
NPI:1841365657
Name:BARROSO, CARLOS MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MANUEL
Last Name:BARROSO
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 1:780 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4546
Mailing Address - Country:US
Mailing Address - Phone:305-888-7955
Mailing Address - Fax:
Practice Address - Street 1:456 W 51ST PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3620
Practice Address - Country:US
Practice Address - Phone:305-819-7770
Practice Address - Fax:305-819-8898
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 45745208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice