10D1079440 CLIA NUMBER - ROBERT A ROSEN MD PA

Laboratory Demographics

CLIA Number: 10D1079440

Facility Name: ROBERT A ROSEN MD PA

Facility Address:
4929 SW 148TH AVE
DAVIE, FL
ZIP 33330
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Facility Phone Number: 954 434-7210

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1245259084

Taxonomy: 363LA2200X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D1079440
LAB Type	Other
Facility Name	ROBERT A ROSEN MD PA
Street	4929 SW 148TH AVE
City	DAVIE
State	FL
ZIP	33330
Phone	954 434-7210
CertificateType	4
CertificateEffectiveDate	1/31/2024
CertificateExpirationDate	1/30/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024