Healthcare Provider Details

I. General information

NPI: 1598713976
Provider Name (Legal Business Name): JOSE ROSA-OLIVARES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155
US

IV. Provider business mailing address

PO BOX 557367
MIAMI FL
33255-7367
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-6505
  • Fax: 305-669-6447
Mailing address:
  • Phone: 786-624-5845
  • Fax: 786-624-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME78113
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME78113
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberME78113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: