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General NPI Number Information
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NPI Number | 1497055685
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Entity Type | Individual
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Provider Name | RORTANA OUM AAC
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Gender | Male
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 3100 E FLETCHER AVE
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City | TAMPA
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State | FL
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Zip | 33613-4613
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Country | US
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Telephone | 813-615-7848
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Fax |
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Provider Business Mailing Address
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Address Line | 13560 CYPRESS GLEN LN UNIT 201
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City | TAMPA
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State | FL
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Zip | 33637-1116
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Country | US
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Telephone | 913-661-4676
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | AA68
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License Number State | FL
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