Basic Information
| Provider Information | |||||||||
| NPI: | 1467672790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSARIO CACHO | ||||||||
| FirstName: | JOAQUIN | ||||||||
| MiddleName: | OMAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3885 OAKWATER CIR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328066257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078165700 | ||||||||
| FaxNumber: | 4074380507 | ||||||||
| Practice Location | |||||||||
| Address1: | 3885 OAKWATER CIR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328066257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078515600 | ||||||||
| FaxNumber: | 4074380507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2007 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME95273 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | ME95273 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RN0300X | ME95273 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 27738 | 01 | FL | BC/BS | OTHER | 000369800 | 05 | FL | MEDICAID |