Provider Demographics
NPI:1780617407
Name:CARRERA, ROSA FLORES (MD)
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:FLORES
Last Name:CARRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 OCEAN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230
Mailing Address - Country:US
Mailing Address - Phone:718-336-4806
Mailing Address - Fax:718-336-4308
Practice Address - Street 1:1833 EAST 13TH STREET
Practice Address - Street 2:SUITE 1B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-859-3769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113331-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00205610Medicaid
NY00203610Medicaid
NYB18954Medicare UPIN
NY00203610Medicaid