Provider Demographics
NPI:1013223882
Name:ROSENBLUM VICTORIA PA
Entity Type:Organization
Organization Name:ROSENBLUM VICTORIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:OLGA
Authorized Official - Last Name:ROSENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-443-4973
Mailing Address - Street 1:13141 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2701
Mailing Address - Country:US
Mailing Address - Phone:954-443-4973
Mailing Address - Fax:
Practice Address - Street 1:13141 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2701
Practice Address - Country:US
Practice Address - Phone:954-443-4973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 43839291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME 43839OtherMEDICAL LISCENSE
96475Medicare UPIN