Healthcare Provider Details

I. General information

NPI: 1447846613
Provider Name (Legal Business Name): NATHALIE ROJAS MOREY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 S DALE MABRY HWY STE C
TAMPA FL
33629-6322
US

IV. Provider business mailing address

5329 SOUTHWICK DR
TAMPA FL
33624-4125
US

V. Phone/Fax

Practice location:
  • Phone: 813-254-6838
  • Fax: 813-254-4779
Mailing address:
  • Phone: 813-562-2235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberR225-620896090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: