Provider Demographics
NPI:1881791234
Name:BARDISA, ROSELIND (DO)
Entity type:Individual
Prefix:
First Name:ROSELIND
Middle Name:
Last Name:BARDISA
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 1:7374 SW 93RD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3246
Mailing Address - Country:US
Mailing Address - Phone:305-661-2002
Mailing Address - Fax:305-661-2003
Practice Address - Street 1:7374 SW 93RD AVE STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3246
Practice Address - Country:US
Practice Address - Phone:305-661-2002
Practice Address - Fax:305-661-2003
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 8030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine