Provider Demographics
NPI:1013162213
Name:LOURDES BOSCH MD PA
Entity type:Organization
Organization Name:LOURDES BOSCH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-642-2600
Mailing Address - Street 1:351 NW LEJEUNE RD SUITE 406
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5689
Mailing Address - Country:US
Mailing Address - Phone:305-642-2600
Mailing Address - Fax:305-642-8887
Practice Address - Street 1:351 NW LEJEUNE RD SUITE 406
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5689
Practice Address - Country:US
Practice Address - Phone:305-642-2600
Practice Address - Fax:305-642-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043744207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD79005Medicare UPIN