Basic Information
Provider Information
NPI: 1982144630
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARIAS
FirstName: ANGELICA
MiddleName: ROSELLO
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7744 COLLINS AVE
Address2: UNIT 7
City: MIAMI BEACH
State: FL
PostalCode: 331412968
CountryCode: US
TelephoneNumber: 3059244227
FaxNumber:  
Practice Location
Address1: 6200 SW 73RD ST
Address2:  
City: SOUTH MIAMI
State: FL
PostalCode: 331434679
CountryCode: US
TelephoneNumber: 7866624000
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/28/2017
LastUpdateDate: 02/28/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X114683FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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