Provider Demographics
NPI:1891783221
Name:ROSENDO, LEYBERTH MARIO (MD)
Entity Type:Individual
Prefix:
First Name:LEYBERTH
Middle Name:MARIO
Last Name:ROSENDO
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 1:661 E ALTAMONTE DR STE 324
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5103
Mailing Address - Country:US
Mailing Address - Phone:407-303-3031
Mailing Address - Fax:407-303-3047
Practice Address - Street 1:661 E ALTAMONTE DR STE 324
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5103
Practice Address - Country:US
Practice Address - Phone:407-303-3031
Practice Address - Fax:407-303-3047
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252128800Medicaid
G03535Medicare UPIN
FL252128800Medicaid