Provider Demographics
NPI:1316536675
Name:ROSARIO, LUCIA
Entity Type:Individual
Prefix:MRS
First Name:LUCIA
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8844 SW 176TH TER
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5801
Mailing Address - Country:US
Mailing Address - Phone:305-972-7836
Mailing Address - Fax:305-735-6481
Practice Address - Street 1:8844 SW 176TH TER BAY 33157
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5801
Practice Address - Country:US
Practice Address - Phone:305-972-7836
Practice Address - Fax:305-735-6481
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3295208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice