Healthcare Provider Details

I. General information

NPI: 1811219256
Provider Name (Legal Business Name): VERA MARIE ROSADO-ODOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 DON WICKHAM DR STE 115
CLERMONT FL
34711-1977
US

IV. Provider business mailing address

1920 DON WICKHAM DR STE 115
CLERMONT FL
34711-1977
US

V. Phone/Fax

Practice location:
  • Phone: 407-423-1039
  • Fax: 407-425-2347
Mailing address:
  • Phone: 407-423-1039
  • Fax: 407-425-2347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME124177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: