Provider Demographics
NPI:1285967869
Name:PEDRO U DE LA ROSA COSTA MD PA
Entity type:Organization
Organization Name:PEDRO U DE LA ROSA COSTA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:U
Authorized Official - Last Name:DE LA ROSA COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-273-4777
Mailing Address - Street 1:8525 SW 92 ST
Mailing Address - Street 2:STE D-15
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7356
Mailing Address - Country:US
Mailing Address - Phone:305-273-4777
Mailing Address - Fax:304-273-4770
Practice Address - Street 1:1423 ALHAMBRA CIRCLE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3523
Practice Address - Country:US
Practice Address - Phone:305-273-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47729207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044901600Medicaid
FL02403Medicare PIN
FL044901600Medicaid