Provider Demographics
NPI:1700995495
Name:JOHNSON, ROSANNA E (DO)
Entity Type:Individual
Prefix:
First Name:ROSANNA
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 NW 27 AVE
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054
Mailing Address - Country:US
Mailing Address - Phone:305-688-3800
Mailing Address - Fax:305-687-1011
Practice Address - Street 1:14701 NW 27 AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054
Practice Address - Country:US
Practice Address - Phone:305-688-3800
Practice Address - Fax:305-687-1011
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8240207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H93405Medicare UPIN