Provider Demographics
NPI:1104808153
Name:ROSARIO, CRISTOBAL (MD)
Entity type:Individual
Prefix:DR
First Name:CRISTOBAL
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 TAMPA RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3676
Mailing Address - Country:US
Mailing Address - Phone:727-786-6155
Mailing Address - Fax:727-781-9899
Practice Address - Street 1:3890 TAMPA RD
Practice Address - Street 2:SUITE 307
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3676
Practice Address - Country:US
Practice Address - Phone:727-786-6155
Practice Address - Fax:727-781-9899
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378616100Medicaid
FL264028700Medicaid
FL27470Medicare ID - Type Unspecified
FL264028700Medicaid