Healthcare Provider Details

I. General information

NPI: 1053394247
Provider Name (Legal Business Name): LOURDES TERESA BOSCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 NW LEJEUNE RD SUITE 401
MIAMI FL
33126-5683
US

IV. Provider business mailing address

351 NW LEJEUNE RD SUITE 406
MIAMI FL
33126-5683
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-2600
  • Fax:
Mailing address:
  • Phone: 305-642-2600
  • Fax: 305-261-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME 43744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: