Provider Demographics
NPI:1366467458
Name:ROSALES, JULIO CESAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:CESAR
Last Name:ROSALES
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 1:11880 SW 40TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3584
Mailing Address - Country:US
Mailing Address - Phone:305-225-7330
Mailing Address - Fax:305-225-7314
Practice Address - Street 1:11880 SW 40TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3584
Practice Address - Country:US
Practice Address - Phone:305-225-7330
Practice Address - Fax:305-225-7314
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL71847208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252691300Medicaid
FL252691301Medicaid
FL252691302Medicaid
FL32605VMedicare PIN
FL252691300Medicaid
FL32605Medicare ID - Type Unspecified