Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 18,001 | PR |
Y | 208D00000X | General Practice Physician | ACN 376 | FL |
NPI | 1043539265 |
---|---|
Provider Name | Dr. Coralia Rosa Roca |
First Address | Doral, FL 33126-1828 |
Second Address | Doral, FL 33126-1828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2010 |
Last Update Date | 03/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007653300 | (05) | FL |
HM474Z | (02) | FL |