Provider Demographics
NPI:1407991300
Name:PEDRO PUBLIO BOSCH MD PA
Entity Type:Organization
Organization Name:PEDRO PUBLIO BOSCH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-446-6414
Mailing Address - Street 1:2601 SW 37TH AVE
Mailing Address - Street 2:SUITE 601
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2700
Mailing Address - Country:US
Mailing Address - Phone:305-446-6414
Mailing Address - Fax:305-446-2350
Practice Address - Street 1:2601 SW 37TH AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2700
Practice Address - Country:US
Practice Address - Phone:305-446-6414
Practice Address - Fax:305-446-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0028393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2296999OtherAETNA
FL056894500Medicaid
FL92403OtherBCBS
FL20420OtherNEIGHBORHOOD
FL221876OtherAVMED
FL20420OtherNEIGHBORHOOD