Provider Demographics
NPI:1518934272
Name:DELROSARIO, LEONARDO SISON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:SISON
Last Name:DELROSARIO
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 1:225 W ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4141
Mailing Address - Country:US
Mailing Address - Phone:904-354-3885
Mailing Address - Fax:904-356-8648
Practice Address - Street 1:225 W ASHLEY ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-4141
Practice Address - Country:US
Practice Address - Phone:904-354-3885
Practice Address - Fax:904-356-8648
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27959207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15446Medicare ID - Type Unspecified
FLD21365Medicare UPIN