Healthcare Provider Details

I. General information

NPI: 1225690944
Provider Name (Legal Business Name): ROSALBA FICO HOUSE PHYSICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 10/04/2025
Certification Date: 10/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 10TH AVE N
LAKE WORTH FL
33461-6607
US

IV. Provider business mailing address

10030 NW 41ST ST
DORAL FL
33178-2919
US

V. Phone/Fax

Practice location:
  • Phone: 561-296-2220
  • Fax:
Mailing address:
  • Phone: 305-988-7883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9617446
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11039114
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberHSE28916
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: