Healthcare Provider Details

I. General information

NPI: 1386494821
Provider Name (Legal Business Name): MARIANNA DE MELLO SOUZA ROQUE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 08/22/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 SW 40TH ST. HCA FLORIDA KENDALL HOSPITAL-
MIAMI FL
33175
US

IV. Provider business mailing address

11750 SW 40TH ST. HCA FLORIDA KENDALL HOSPITAL-
MIAMI FL
33175
US

V. Phone/Fax

Practice location:
  • Phone: 305-223-3000
  • Fax:
Mailing address:
  • Phone: 305-223-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: