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General NPI Number Information
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NPI Number | 1164165437
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Entity Type | Organization
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Legal Business Name | ROSA LAURA MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 04/15/2022
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 2335 TAMIAMI TRL N STE 203B
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City | NAPLES
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State | FL
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Zip | 34103-4442
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Country | US
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Telephone | 239-384-9519
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Fax | 786-842-6494
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Provider Business Mailing Address
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Address Line | 630 14TH ST SE
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City | NAPLES
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State | FL
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Zip | 34117-3695
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Country | US
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Telephone | 786-725-8799
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL MORALES
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Credential | MD
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Telephone | 786-725-8799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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