Provider Demographics
NPI:1225690944
Name:FICO, ROSALBA (HOUSE PHYSICIAN)
Entity Type:Individual
Prefix:
First Name:ROSALBA
Middle Name:
Last Name:FICO
Suffix:
Gender:F
Credentials:HOUSE PHYSICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4749 NW 98TH PL
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1927
Mailing Address - Country:US
Mailing Address - Phone:305-988-7883
Mailing Address - Fax:
Practice Address - Street 1:2290 10TH AVE N
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6607
Practice Address - Country:US
Practice Address - Phone:561-296-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE28916208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist