Provider Demographics
NPI:1164165437
Name:ROSA LAURA MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:ROSA LAURA MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-725-8799
Mailing Address - Street 1:630 14TH ST SE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-3695
Mailing Address - Country:US
Mailing Address - Phone:786-725-8799
Mailing Address - Fax:
Practice Address - Street 1:2335 TAMIAMI TRL N STE 203B
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4442
Practice Address - Country:US
Practice Address - Phone:786-725-8799
Practice Address - Fax:786-842-6494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty