=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225737612
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSASS VORTEX
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2023
-----------------------------------------------------
Last Update Date | 05/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2095 HIGHWAY A1A APT 4704
-----------------------------------------------------
City | INDIAN HARBOUR BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32937-1803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-271-7348
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2095 HIGHWAY A1A APT 4704
-----------------------------------------------------
City | INDIAN HARBOUR BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32937-1803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-271-7348
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LUIS ROSAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 321-271-7348
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------