Provider Demographics
NPI:1467672790
Name:ROSARIO CACHO, JOAQUIN OMAR (MD)
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:OMAR
Last Name:ROSARIO CACHO
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 1:3885 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6257
Mailing Address - Country:US
Mailing Address - Phone:407-816-5700
Mailing Address - Fax:407-438-0507
Practice Address - Street 1:3885 OAKWATER CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6257
Practice Address - Country:US
Practice Address - Phone:407-851-5600
Practice Address - Fax:407-438-0507
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95273207R00000X, 208M00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27738OtherBC/BS
FL000369800Medicaid
FL27738OtherBC/BS
FL000369800Medicaid