Healthcare Provider Details

I. General information

NPI: 1134124654
Provider Name (Legal Business Name): ROSA J CUENCA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 W DR MLK BLVD
TAMPA FL
33607-6307
US

IV. Provider business mailing address

3003 W DR MLK JR BLVD MAB 3RD FLOOR
TAMPA FL
33607
US

V. Phone/Fax

Practice location:
  • Phone: 813-870-4438
  • Fax: 813-870-4153
Mailing address:
  • Phone: 813-870-4438
  • Fax: 813-870-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME68683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: