Healthcare Provider Details

I. General information

NPI: 1386984458
Provider Name (Legal Business Name): ATLAS MEDICAL CENTER OF TAMPA,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 N ARMENIA AVE
TAMPA FL
33607-6433
US

IV. Provider business mailing address

4123 N. ARMENIA AVENUE
TAMPA FL
33607
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-9205
  • Fax: 813-374-9901
Mailing address:
  • Phone: 813-374-9205
  • Fax: 813-374-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE RUBIO
Title or Position: PRESIDENT
Credential: MASSAGE THERAPIST
Phone: 813-374-9205