Provider Demographics
NPI:1679589170
Name:GURARYE, ROZA BORIS (MD)
Entity Type:Individual
Prefix:MRS
First Name:ROZA
Middle Name:BORIS
Last Name:GURARYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2020 NE 163RD ST
Mailing Address - Street 2:SUITE 105
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:305-948-8248
Practice Address - Street 1:2020 NE 163RD ST
Practice Address - Street 2:SUITE 105
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:305-948-8248
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD28037Medicare UPIN