=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841289576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOPEDIC SPECIALISTS OF S FLORIDA P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2005
-----------------------------------------------------
Last Update Date | 01/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7100 W 20TH AVE SUITE 101
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-1897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-822-0401
-----------------------------------------------------
Fax | 305-824-1748
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7100 W 20TH AVE SUITE 101
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-1897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-822-0401
-----------------------------------------------------
Fax | 305-824-1748
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ORESTES G ROSABAL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-822-0401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------