Provider Demographics
NPI:1265631378
Name:SOUTH FLORIDA INTERVENTIONAL CARDIOLOGY PA
Entity Type:Organization
Organization Name:SOUTH FLORIDA INTERVENTIONAL CARDIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:DE LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-232-0170
Mailing Address - Street 1:PO BOX 163608
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-3608
Mailing Address - Country:US
Mailing Address - Phone:305-232-0170
Mailing Address - Fax:
Practice Address - Street 1:12002 SW 128TH CT
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4639
Practice Address - Country:US
Practice Address - Phone:305-232-0170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 95915207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty