Provider Demographics
NPI:1255835674
Name:RABASSA, ANDREA MARIA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIA
Last Name:RABASSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 JOE DIMAGGIO DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5487
Mailing Address - Country:US
Mailing Address - Phone:800-437-2672
Mailing Address - Fax:
Practice Address - Street 1:1005 JOE DIMAGGIO DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5402
Practice Address - Country:US
Practice Address - Phone:800-437-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME156788207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program