Provider Demographics
NPI:1730348673
Name:BERRIOS, RICARDO LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:LUIS
Last Name:BERRIOS
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 1:405 W BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7401
Mailing Address - Country:US
Mailing Address - Phone:813-662-3376
Mailing Address - Fax:813-662-3009
Practice Address - Street 1:405 W BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7401
Practice Address - Country:US
Practice Address - Phone:813-662-3376
Practice Address - Fax:813-662-3009
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA64505208D00000X
FLME118963207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice