MEDICARE: KARL ENGELS TAVERA ROSARIO SA-C

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	246ZC0007X	Surgical Assistant	25-177	FL

General Provider Information

NPI Number	:	1093512626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARL ENGELS TAVERA ROSARIO SA-C

Provider Business Mailing Address
First Line	:	1258 PINE RIDGE CIR W APT C2
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-6407
Country	:	US
Telephone Number	:	347-227-5767
Fax Number	:

Provider Business Practice Location Address
First Line	:	1258 PINE RIDGE CIR W APT C2
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-6407
Country	:	US
Telephone Number	:	347-227-5767
Fax Number	:

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

Provider Enumeration Date	:	03/01/2025
Last Update Date	:	03/01/2025

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