Healthcare Provider Details

I. General information

NPI: 1235685496
Provider Name (Legal Business Name): MISS ELIZABETH ROSADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6780 MEADE ST
HOLLYWOOD FL
33024-1814
US

IV. Provider business mailing address

6780 MEADE ST
HOLLYWOOD FL
33024-1814
US

V. Phone/Fax

Practice location:
  • Phone: 786-857-3057
  • Fax:
Mailing address:
  • Phone: 786-857-3057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: