Provider Demographics
NPI:1194850990
Name:R ROSARIO-MEDINA MD LLC
Entity type:Organization
Organization Name:R ROSARIO-MEDINA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO-MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-382-9703
Mailing Address - Street 1:1417 N SEMORAN BLVD
Mailing Address - Street 2:STE 106
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3555
Mailing Address - Country:US
Mailing Address - Phone:407-382-9703
Mailing Address - Fax:321-766-4566
Practice Address - Street 1:1417 N SEMORAN BLVD
Practice Address - Street 2:STE 106
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3555
Practice Address - Country:US
Practice Address - Phone:407-382-9703
Practice Address - Fax:321-766-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB085Medicare PIN
FLG15239Medicare UPIN