Healthcare Provider Details

I. General information

NPI: 1942277868
Provider Name (Legal Business Name): PEDRO U DE LA ROSA-COSTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 SW 92ND. STREET SUITE: D- 15
MIAMI FL
33156-5683
US

IV. Provider business mailing address

1423 ALHAMBRA CIR
CORAL GABLES FL
33134-3523
US

V. Phone/Fax

Practice location:
  • Phone: 305-273-4777
  • Fax: 305-273-4770
Mailing address:
  • Phone: 305-643-6500
  • Fax: 305-642-4995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME 0047729
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: