MEDICARE: DR. ANA MARISOL CONDE-ROSA 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	207RI0200X	Infectious Disease Physician	ME112217	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	GF926U	OTHER	FL	MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972674687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANA MARISOL CONDE-ROSA MD

Provider Business Mailing Address
First Line	:	378 N BABCOCK ST
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-7344
Country	:	US
Telephone Number	:	321-372-5003
Fax Number	:	321-345-5671

Provider Business Practice Location Address
First Line	:	378 N BABCOCK ST
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-7344
Country	:	US
Telephone Number	:	321-372-5003
Fax Number	:	321-345-5671

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	11/10/2025

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