Provider Demographics
NPI:1093742108
Name:DESOUZA, RICARDO J (CRNA)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:J
Last Name:DESOUZA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MERIDIAN AVE APT 330
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1536
Mailing Address - Country:US
Mailing Address - Phone:786-546-3975
Mailing Address - Fax:786-546-3975
Practice Address - Street 1:1400 NW 12TH AVE
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1003
Practice Address - Country:US
Practice Address - Phone:305-325-5416
Practice Address - Fax:954-964-6084
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9185790367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3927ZMedicare ID - Type Unspecified