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General NPI Number Information
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NPI Number | 1326190802
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Entity Type | Organization
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Legal Business Name | FLORIDA PODIATRY GROUP PA
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 631 SW 23RD RD
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City | MIAMI
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State | FL
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Zip | 33129-1929
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Country | US
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Telephone | 305-854-2222
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Fax | 305-854-8581
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Provider Business Mailing Address
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Address Line | 8415 SW 24TH ST SUITE 204
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City | MIAMI
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State | FL
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Zip | 33155-2305
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Country | US
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Telephone | 305-854-2222
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Fax | 305-854-8581
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA M. ROSAS-GUYON
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Credential | DPM
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Telephone | 305-854-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO2583
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License Number State | FL
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