Healthcare Provider Details

I. General information

NPI: 1043874472
Provider Name (Legal Business Name): ROLANDO ARTURO ZAMORA GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date: 12/16/2019
Reactivation Date: 01/30/2020

III. Provider practice location address

1611 NW 12 AVENUE
MIAMI FL
33136
US

IV. Provider business mailing address

16 NW 12 AVE SUITE CENTRAL 600-D
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5215
  • Fax:
Mailing address:
  • Phone: 305-585-5215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN29737
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: