Provider Demographics
NPI:1568465342
Name:MENA, ROSA M (MD)
Entity type:Individual
Prefix:DR
First Name:ROSA
Middle Name:M
Last Name:MENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSA
Other - Middle Name:MARIA
Other - Last Name:LEMBCKE-MENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 511567
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-1567
Mailing Address - Country:US
Mailing Address - Phone:941-883-3225
Mailing Address - Fax:941-883-3230
Practice Address - Street 1:21216 OLEAN BLVD
Practice Address - Street 2:STE 8
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6722
Practice Address - Country:US
Practice Address - Phone:941-883-3225
Practice Address - Fax:941-883-3230
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00128080OtherRAILROAD MEDICARE
FL41399OtherFL BLUE CROSS/BLUE SHIELD
FL2379480OtherAETNA
FL2416243OtherCIGNA
FLG56462Medicare UPIN
FL41399AMedicare ID - Type UnspecifiedMEDICARE