Provider Demographics
NPI:1558475194
Name:ROSARIO ROBLES, IVETTE (MD)
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:ROSARIO ROBLES
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 1:308 W BASS ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5001
Mailing Address - Country:US
Mailing Address - Phone:407-483-8801
Mailing Address - Fax:407-483-1298
Practice Address - Street 1:708 E COLONIAL DR STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4652
Practice Address - Country:US
Practice Address - Phone:407-895-9255
Practice Address - Fax:407-898-9019
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138834207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2126OtherPREFERED MEDICARE CHOICE
PR43080782OtherUIA
PR212266OtherPREFERED HEALTH PLAN
PR660606429OtherMMM
PR6420016OtherHUMANA INSURANCE
PR82259OtherTRIPLE S
PR212266OtherPREFERED HEALTH PLAN
PR2126OtherPREFERED MEDICARE CHOICE