| Entity Name: | ANGEL M. ROSARIO, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 23 Dec 1991 (33 years ago) |
| Document Number: | V02666 |
| FEI/EIN Number | 593153969 |
| Address: | 6919 N DALE MABRY HWY, TAMPA, FL, 33614, US |
| Mail Address: | 6919 N.Dale Mabry Hwy., Tampa, FL, 33614, US |
| ZIP code: | 33614 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174792725 | 2008-02-28 | 2013-07-31 | 6919 N DALE MABRY HWY, SUITE 320, TAMPA, FL, 336143972, US | 6919 N DALE MABRY HWY, SUITE 320, TAMPA, FL, 336143972, US | |||||||||||||||||||||||||
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| Phone | +1 813-930-8816 |
| Fax | 8139321856 |
Authorized person
| Name | ALICE M BALDOCK |
| Role | BILLING |
| Phone | 8139302406 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME53996 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 058398700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ROSARIO, ANGEL M. | Agent | 6919 N DALE MABRY HWY, TAMPA, FL, 33614 |
| Name | Role | Address |
|---|---|---|
| ROSARIO, ANGEL M. | President | 6919 N DALE MABRY HWY, TAMPA, FL, 33614 |
| Name | Role | Address |
|---|---|---|
| ROSARIO, ANGEL M. | Director | 6919 N DALE MABRY HWY, TAMPA, FL, 33614 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
