Provider Demographics
NPI:1518922319
Name:MARRON-FERNANDEZ, ROSA AMELIA (MD)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:AMELIA
Last Name:MARRON-FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12788 W FOREST HILL BLVD
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4703
Mailing Address - Country:US
Mailing Address - Phone:561-793-3232
Mailing Address - Fax:561-793-0490
Practice Address - Street 1:12788 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 1001
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4703
Practice Address - Country:US
Practice Address - Phone:561-793-3232
Practice Address - Fax:561-793-0490
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00289582080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD86355Medicare UPIN
79556Medicare ID - Type Unspecified