Provider Demographics
NPI:1134420433
Name:ROSENDO V. DE POSADA MEDICAL OFFICE, CORP
Entity type:Organization
Organization Name:ROSENDO V. DE POSADA MEDICAL OFFICE, CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSENDO
Authorized Official - Middle Name:VALDES
Authorized Official - Last Name:DE POSADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-261-0964
Mailing Address - Street 1:615 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3970
Mailing Address - Country:US
Mailing Address - Phone:305-261-0964
Mailing Address - Fax:305-262-5403
Practice Address - Street 1:615 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3970
Practice Address - Country:US
Practice Address - Phone:305-261-0964
Practice Address - Fax:305-262-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30133208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL92727Medicare PIN
FLD60159Medicare UPIN