Provider Demographics
NPI:1801829189
Name:MOURA, ROSSANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSSANA
Middle Name:
Last Name:MOURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ROSSANA
Other - Middle Name:MOURA
Other - Last Name:ROCHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1601 N PALM AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3242
Mailing Address - Country:US
Mailing Address - Phone:954-874-7900
Mailing Address - Fax:954-874-7901
Practice Address - Street 1:1601 N PALM AVE STE 311
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3242
Practice Address - Country:US
Practice Address - Phone:954-874-7900
Practice Address - Fax:954-874-7901
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMD10776207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME79901OtherMEDICAL LICENSE
H54061Medicare UPIN