Basic Information
| Provider Information | |||||||||
| NPI: | 1386601284 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSARIO | ||||||||
| FirstName: | AILEEN | ||||||||
| MiddleName: | EDITH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 S HARBOUR ISLAND BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336025925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632156639 | ||||||||
| FaxNumber: | 8443886186 | ||||||||
| Practice Location | |||||||||
| Address1: | 5626 CURRY FORD RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328221424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075566222 | ||||||||
| FaxNumber: | 8443886186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ACN1091 | FL | Y | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 13786 | PR | N | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.