Provider Demographics
NPI:1770571945
Name:ZALDIVAR, ROGELIO J (MD)
Entity type:Individual
Prefix:
First Name:ROGELIO
Middle Name:J
Last Name:ZALDIVAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7500 SW 8TH ST
Mailing Address - Street 2:STE 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4400
Mailing Address - Country:US
Mailing Address - Phone:305-264-5202
Mailing Address - Fax:305-264-5919
Practice Address - Street 1:7500 SW 8TH ST
Practice Address - Street 2:STE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4400
Practice Address - Country:US
Practice Address - Phone:305-264-5202
Practice Address - Fax:305-264-5919
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0037914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066789700Medicaid
FL066789700Medicaid
95881 RMedicare ID - Type Unspecified