Provider Demographics
NPI:1124252838
Name:CRISTOBAL R. ROSARIO M.D., P.A.
Entity type:Organization
Organization Name:CRISTOBAL R. ROSARIO M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:CRISTOBAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-786-6155
Mailing Address - Street 1:3890 TAMPA ROAD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3677
Mailing Address - Country:US
Mailing Address - Phone:727-786-6155
Mailing Address - Fax:727-781-9899
Practice Address - Street 1:3890 TAMPA ROAD
Practice Address - Street 2:SUITE 307
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3677
Practice Address - Country:US
Practice Address - Phone:727-786-6155
Practice Address - Fax:727-781-9899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRISTOBAL R. ROSARIO M.D., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264028700Medicaid
FL378616100Medicaid
FL27470Medicare PIN
FLG17480Medicare UPIN