Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME132402 | FL |
NPI | 1083667984 |
---|---|
Provider Name | Dr. Raymond E De La Rosa |
First Address | Bradenton, FL 34212-5016 |
Second Address | Englewood, FL 34224-8616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 23/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30918 | STATE LICENSE (01) | KY |
64309180 | (05) | KY |
G11366 | (02) |