Healthcare Provider Details

I. General information

NPI: 1396805149
Provider Name (Legal Business Name): ROSE JOSEPH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16401 NW 2ND AVE SUITE 202
MIAMI FL
33169-6036
US

IV. Provider business mailing address

16401 NW 2ND AVE SUITE 202
MIAMI FL
33169-6036
US

V. Phone/Fax

Practice location:
  • Phone: 305-947-4734
  • Fax: 305-944-0619
Mailing address:
  • Phone: 305-947-4734
  • Fax: 305-944-0619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME59619
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: