Healthcare Provider Details

I. General information

NPI: 1700291333
Provider Name (Legal Business Name): RAUL ALEJANDRO ROSARIO-CONCEPCION M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15955 SW 96TH ST STE 406
MIAMI FL
33196-1273
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384
UM

V. Phone/Fax

Practice location:
  • Phone: 786-596-3876
  • Fax: 786-533-9989
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME136095
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number66291
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME136095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: