Provider Demographics
NPI:1467696286
Name:ROZA GURARYE, MD, PA
Entity Type:Organization
Organization Name:ROZA GURARYE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROZA
Authorized Official - Middle Name:BORIS
Authorized Official - Last Name:GURARYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-785-7793
Mailing Address - Street 1:2020 NE 163RD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4927
Mailing Address - Country:US
Mailing Address - Phone:305-948-3985
Mailing Address - Fax:
Practice Address - Street 1:2020 NE 163RD ST STE 105
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4927
Practice Address - Country:US
Practice Address - Phone:305-948-3985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042371800Medicaid
FLD28037Medicare UPIN
FL96911Medicare PIN