Provider Demographics
NPI:1912047390
Name:MID FLORIDA PRIMARY CARE PHYSICIANS ASSOCIATES, P.A
Entity Type:Organization
Organization Name:MID FLORIDA PRIMARY CARE PHYSICIANS ASSOCIATES, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEYBERTH
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:ROSENDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-889-8008
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32704-0909
Mailing Address - Country:US
Mailing Address - Phone:407-889-8008
Mailing Address - Fax:407-889-8570
Practice Address - Street 1:1475 W US HWY 441
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712
Practice Address - Country:US
Practice Address - Phone:407-889-8008
Practice Address - Fax:407-889-8570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72708261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGO3535Medicare UPIN
FL41537AMedicare ID - Type Unspecified