Provider Demographics
NPI:1780062232
Name:ROSELL, MARTIN ALFREDO (HAS TRAINEE)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:ALFREDO
Last Name:ROSELL
Suffix:
Gender:M
Credentials:HAS TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1888 PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-286-3186
Practice Address - Street 1:806 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744
Practice Address - Country:US
Practice Address - Phone:407-910-4700
Practice Address - Fax:407-910-4701
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAST452237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist