Provider Demographics
NPI:1790190718
Name:ROSERO BASURTO, MARIA FERNANDA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:ROSERO BASURTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16400 S HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:WEIRSDALE
Mailing Address - State:FL
Mailing Address - Zip Code:32195-2442
Mailing Address - Country:US
Mailing Address - Phone:352-821-9797
Mailing Address - Fax:352-821-0553
Practice Address - Street 1:16400 S HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:WEIRSDALE
Practice Address - State:FL
Practice Address - Zip Code:32195-2442
Practice Address - Country:US
Practice Address - Phone:352-821-9797
Practice Address - Fax:352-821-0553
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine