Basic Information
| Provider Information | |||||||||
| NPI: | 1033183686 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LABARBERA | ||||||||
| FirstName: | LOUIS | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3641 S MIAMI AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331334204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058540302 | ||||||||
| FaxNumber: | 3058540308 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 W COMMERCIAL BLVD | ||||||||
| Address2: | STE 5 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333093300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054855666 | ||||||||
| FaxNumber: | 9544841651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 01/16/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 2739102 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | P00955275 | 01 | FL | MEDICARE RAILROAD | OTHER | 018963200 | 05 | FL | MEDICAID |