MEDICARE: ROSENDO V. DE POSADA MEDICAL OFFICE, CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	ME30133	FL

General Provider Information

NPI Number	:	1134420433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSENDO V. DE POSADA MEDICAL OFFICE, CORP

Provider Business Mailing Address
First Line	:	615 SW 57TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-3970
Country	:	US
Telephone Number	:	305-261-0964
Fax Number	:	305-262-5403

Provider Business Practice Location Address
First Line	:	615 SW 57TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-3970
Country	:	US
Telephone Number	:	305-261-0964
Fax Number	:	305-262-5403

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	ROSENDO VALDES DE POSADA
Credential	:	M.D.
Telephone Number	:	305-261-0964

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	03/01/2013

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