Provider Demographics
NPI:1891176038
Name:DE LA ROSA OGANDO, JENNIFFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFFER
Middle Name:
Last Name:DE LA ROSA OGANDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5717 RED BUG LAKE RD STE 341
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4957
Mailing Address - Country:US
Mailing Address - Phone:321-207-0174
Mailing Address - Fax:321-207-0175
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
Practice Address - Country:US
Practice Address - Phone:352-821-9797
Practice Address - Fax:352-821-0553
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME134567207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine