Provider Demographics
NPI:1326084674
Name:ROSARIO-MEDINA, RALPH (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:ROSARIO-MEDINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 CURRY FORD RD STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-2704
Mailing Address - Country:US
Mailing Address - Phone:407-382-9703
Mailing Address - Fax:321-766-4566
Practice Address - Street 1:4711 CURRY FORD RD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2704
Practice Address - Country:US
Practice Address - Phone:407-382-9703
Practice Address - Fax:321-766-4566
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG15239Medicare UPIN
FL26666SMedicare PIN