Provider Demographics
NPI:1043292105
Name:QUIROS MESA, ANAMARY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANAMARY
Middle Name:
Last Name:QUIROS MESA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12101 PINE NEEDLE LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5722
Mailing Address - Country:US
Mailing Address - Phone:786-371-4130
Mailing Address - Fax:
Practice Address - Street 1:1545 SAN REMO AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3008
Practice Address - Country:US
Practice Address - Phone:305-403-4930
Practice Address - Fax:305-403-4940
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL764572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259731400Medicaid
FL35800ZMedicare PIN
FL259731400Medicaid