MEDICARE: LEYBERTH MARIO ROSENDO MD

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	207Q00000X	Family Medicine Physician	ME72708	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891783221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEYBERTH MARIO ROSENDO MD

Provider Business Mailing Address
First Line	:	661 E ALTAMONTE DR STE 324
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5103
Country	:	US
Telephone Number	:	407-303-3031
Fax Number	:	407-303-3047

Provider Business Practice Location Address
First Line	:	661 E ALTAMONTE DR STE 324
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5103
Country	:	US
Telephone Number	:	407-303-3031
Fax Number	:	407-303-3047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	08/19/2020

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Directions to “ LEYBERTH MARIO ROSENDO MD” Practice Location

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