Provider Demographics
NPI:1235695495
Name:ROSARIO, TEMISTOCLES
Entity Type:Individual
Prefix:
First Name:TEMISTOCLES
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 NW 99TH CT APT 103
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3306
Mailing Address - Country:US
Mailing Address - Phone:786-731-8875
Mailing Address - Fax:
Practice Address - Street 1:9301 SW 56TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-6559
Practice Address - Country:US
Practice Address - Phone:786-731-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR260-807-71-401-0OtherDRIVE LICENSE