Provider Demographics
NPI:1982321089
Name:LA ROSA, ANIEL
Entity type:Individual
Prefix:
First Name:ANIEL
Middle Name:
Last Name:LA ROSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANIEL
Other - Middle Name:
Other - Last Name:LA ROSA ABASCAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:19721 NW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6403
Mailing Address - Country:US
Mailing Address - Phone:786-899-6309
Mailing Address - Fax:
Practice Address - Street 1:19721 NW 77TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6403
Practice Address - Country:US
Practice Address - Phone:786-899-6309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9497132163W00000X
FL11022202363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse