Provider Demographics
NPI:1538450564
Name:ROSEMARY DAVILA-SOLA DPM PA
Entity type:Organization
Organization Name:ROSEMARY DAVILA-SOLA DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA-SOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-984-1154
Mailing Address - Street 1:201 178TH DR
Mailing Address - Street 2:SUITE 219
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2875
Mailing Address - Country:US
Mailing Address - Phone:305-984-1154
Mailing Address - Fax:305-642-5213
Practice Address - Street 1:3051 WEST FLAGLER STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1257
Practice Address - Country:US
Practice Address - Phone:305-984-1154
Practice Address - Fax:305-642-5213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-01666213E00000X
FLPO-0001666213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003619900Medicaid
FLP11000032766OtherCORPORATION