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General NPI Number Information
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NPI Number | 1942506993
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Entity Type | Organization
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Legal Business Name | ROSENBERG CLINIC
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 5190 NW 167TH ST SUITE222
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City | MIAMI GARDENS
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State | FL
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Zip | 33014-6328
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Country | US
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Telephone | 305-624-0746
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Fax | 305-624-0749
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Provider Business Mailing Address
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Address Line | 5190 NW 167TH ST SUITE222
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City | MIAMI GARDENS
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State | FL
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Zip | 33014-6328
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Country | US
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Telephone | 305-624-0746
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Fax | 305-624-0749
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Authorized Official
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Title or Position | OWNER
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Name | ARIEL GONZALEZ
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Credential | MM
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Telephone | 305-624-0746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MM 26100
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License Number State | FL
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