Healthcare Provider Details

I. General information

NPI: 1093742108
Provider Name (Legal Business Name): RICARDO J. DESOUZA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE ANESTHESIA DEPARTMENT
MIAMI FL
33136-1003
US

IV. Provider business mailing address

2001 MERIDIAN AVE APT 330
MIAMI BEACH FL
33139-1536
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-5416
  • Fax: 954-964-6084
Mailing address:
  • Phone: 786-546-3975
  • Fax: 786-546-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9185790
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: