Healthcare Provider Details

I. General information

NPI: 1790931491
Provider Name (Legal Business Name): PEDIATRIC PULMONARY SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10817 BLOOMINGDALE AVE
RIVERVIEW FL
33578-3616
US

IV. Provider business mailing address

PO BOX 151637
TAMPA FL
33684-1637
US

V. Phone/Fax

Practice location:
  • Phone: 813-870-1995
  • Fax: 813-875-1889
Mailing address:
  • Phone: 813-870-1995
  • Fax: 813-875-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID ROSENBERG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 813-870-1995