Healthcare Provider Details

I. General information

NPI: 1942253281
Provider Name (Legal Business Name): CARMEN R DELAROSA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MILESTONE BLVD
CANTONMENT FL
32533-6579
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-478-2333
  • Fax: 850-478-1809
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME49247
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: