Provider Demographics
NPI:1336317171
Name:BERZOSA CORELLA, MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:BERZOSA CORELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MANUEL
Other - Middle Name:
Other - Last Name:BERZOSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4300 ALTON RD
Mailing Address - Street 2:GUMENICK BUILDING, SUITE 2522
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2948
Mailing Address - Country:US
Mailing Address - Phone:305-674-2240
Mailing Address - Fax:305-674-3961
Practice Address - Street 1:4300 ALTON RD
Practice Address - Street 2:GUMENICK BUILDING, SUITE 2522
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2948
Practice Address - Country:US
Practice Address - Phone:305-674-2849
Practice Address - Fax:305-535-7919
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116511207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336317171OtherNPI