Healthcare Provider Details

I. General information

NPI: 1538170147
Provider Name (Legal Business Name): CARLA ROSCIO CORDOVA MD ANESTHESIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA ROSCIO RODRIGUEZ MD

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE, C302 UNIVERSITY OF MIAMI, DEPARTMENT OF ANESTHESIOLOGY
MIAMI FL
33101
US

IV. Provider business mailing address

PO BOX 016370 (R-370) 1611 NW 12TH AVE, C302. UM ANESTHESIOLOGY
MIAMI FL
33101
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1446
  • Fax: 305-545-7094
Mailing address:
  • Phone: 305-585-1446
  • Fax: 305-545-7094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number016423
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME100236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: