Healthcare Provider Details

I. General information

NPI: 1962466987
Provider Name (Legal Business Name): ROBERTO COSME HEROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 12TH AVENUE
MIAMI FL
33136
US

IV. Provider business mailing address

1095 NW 14TH TERRACE
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6946
  • Fax: 305-243-3337
Mailing address:
  • Phone: 305-243-6946
  • Fax: 305-243-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME75208
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME0075208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: