Provider Demographics
NPI:1861033367
Name:BLUE ROSE MEDICAL GROUP CORP
Entity Type:Organization
Organization Name:BLUE ROSE MEDICAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AFRANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHEMENDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-842-8312
Mailing Address - Street 1:1399 NW 17TH AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2334
Mailing Address - Country:US
Mailing Address - Phone:305-842-8312
Mailing Address - Fax:
Practice Address - Street 1:1399 NW 17TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2334
Practice Address - Country:US
Practice Address - Phone:305-842-8312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-05
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health