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5803 Nw 151st St Ste 102-103 Miami Lakes FL 33014-2495 | |
| (786) 899-0119 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 5803 Nw 151st St Ste 102-103, Miami Lakes, Florida |
| Authorized Official Name and Position | Ihosvani Barroso (PRESIDENT) |
| Authorized Official Contact | 7868990119 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4835 E 4th Ave Ste B Hialeah FL 33013-1814 Ph: (305) 613-7986 | 5803 Nw 151st St Ste 102-103 Miami Lakes FL 33014-2495 Ph: (786) 899-0119 |
| NPI Number | 1245756576 |
|---|---|
| Provider Enumeration Date | 08/17/2017 |
| Last Update Date | 01/02/2025 |
| Medicare PECOS PAC ID | 1557622107 |
|---|---|
| Medicare Enrollment ID | O20180223000516 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245756576 | NPI | - | NPPES |
| 022004900 | Medicaid | FL | |
| ME122334 | Other | FL | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Ihosvani Barroso |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1992058408 PECOS PAC ID: 3870891955 Enrollment ID: I20160406002041 |
| Provider Name | Aurora Del Pilar Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033851449 PECOS PAC ID: 3678940095 Enrollment ID: I20221027002082 |
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