Basic Information
Provider Information
NPI: 1518578392
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARRERO
FirstName: JEANNETTE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RBT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1500 S DOUGLAS RD STE 230
Address2:  
City: CORAL GABLES
State: FL
PostalCode: 331344108
CountryCode: US
TelephoneNumber: 8448541116
FaxNumber: 3058469711
Practice Location
Address1: 1500 S DOUGLAS RD STE 230
Address2:  
City: CORAL GABLES
State: FL
PostalCode: 331344108
CountryCode: US
TelephoneNumber: 8448541116
FaxNumber: 3058469711
Other Information
ProviderEnumerationDate: 08/13/2020
LastUpdateDate: 08/14/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000XRBT-20-119217FLY    

No ID Information.


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