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General NPI Number Information
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NPI Number | 1336496629
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Entity Type | Organization
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Legal Business Name | DR. ROSIE'S PEDIATRICS
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 466 SW PORT SAINT LUCIE BLVD., SUITE 116
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-2091
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Country | US
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Telephone | 772-341-7433
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Fax | 772-237-4622
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Provider Business Mailing Address
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Address Line | 466 SW PORT SAINT LUCIE BLVD., SUITE 116
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-2091
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Country | US
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Telephone | 772-341-7433
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Fax | 772-237-4622
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Authorized Official
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Title or Position | OWNER
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Name | ROSARIO CORREA
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Credential | APRN
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Telephone | 772-341-7433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME91787
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License Number State | FL
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