Provider Information for 1164869871
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KIZZY ANN M ROSE
Sex: Female
NPI: 1164869871
Last Updated: 2013-06-04
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1164869871 | ||||||||
| Enumeration Date | 2013-06-04 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 11031 NE 6TH AVE MIAMI, FL 33161-7182 United States Phone: 305-398-6100 | Fax:305-398-6099 | ||||||||
| Primary Practice Address | 140 NW 59TH ST MIAMI, FL 33127-1218 United States Phone: 305-759-8888 | Fax:305-757-5989 | ||||||||
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