Provider Demographics
NPI:1023077047
Name:SULBARAN, TULIO A (MD)
Entity type:Individual
Prefix:DR
First Name:TULIO
Middle Name:A
Last Name:SULBARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N MANGOUSTINE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1004
Mailing Address - Country:US
Mailing Address - Phone:407-321-1415
Mailing Address - Fax:407-321-1597
Practice Address - Street 1:305 N MANGOUSTINE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1004
Practice Address - Country:US
Practice Address - Phone:407-321-1415
Practice Address - Fax:407-321-1597
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90847174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271134600Medicaid
50159OtherBCBS
FL375047OtherWELLCARE
FLP00382428OtherRAILROAD MEDICARE
50159OtherBCBS
FL375047OtherWELLCARE