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General NPI Number Information
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NPI Number | 1265631378
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA INTERVENTIONAL CARDIOLOGY PA
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 12002 SW 128TH CT SUITE 204
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City | MIAMI
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State | FL
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Zip | 33186-4639
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Country | US
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Telephone | 305-232-0170
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 163608
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City | MIAMI
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State | FL
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Zip | 33116-3608
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Country | US
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Telephone | 305-232-0170
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ARIEL JESUS DE LA ROSA
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Credential | M.D.
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Telephone | 305-232-0170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME 95915
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License Number State | FL
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