Provider Demographics
NPI:1336496629
Name:DR. ROSIE'S PEDIATRICS
Entity Type:Organization
Organization Name:DR. ROSIE'S PEDIATRICS
Other - Org Name:KID'S PLACE PEDIATRICS, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:772-341-7433
Mailing Address - Street 1:466 SW PORT SAINT LUCIE BLVD., SUITE 116
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2091
Mailing Address - Country:US
Mailing Address - Phone:772-341-7433
Mailing Address - Fax:772-237-4622
Practice Address - Street 1:466 SW PORT SAINT LUCIE BLVD., SUITE 116
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2091
Practice Address - Country:US
Practice Address - Phone:772-341-7433
Practice Address - Fax:772-237-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91787208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271863400Medicaid
FLU4547AOtherMEDICARE
FLU4547AOtherMEDICARE