Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | ME 43744 | FL |
NPI | 1053394247 |
---|---|
Provider Name | Lourdes Teresa Bosch |
First Address | Miami, FL 33126-5683 |
Second Address | Miami, FL 33126-5683 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 14/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053081600 | (05) | FL |
D79005 | (02) | FL |