Healthcare Provider Details

I. General information

NPI: 1902807068
Provider Name (Legal Business Name): EDDIE RESQUITES HERMOSISIMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S MAIN ST
KANNAPOLIS NC
28081-4915
US

IV. Provider business mailing address

707 S MAIN ST
KANNAPOLIS NC
28081-4915
US

V. Phone/Fax

Practice location:
  • Phone: 704-933-1151
  • Fax: 704-933-1155
Mailing address:
  • Phone: 704-933-1151
  • Fax: 704-933-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number23031
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: