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General NPI Number Information
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NPI Number | 1578503751
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Entity Type | Individual
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Provider Name | ROSA A. VIDAL MD
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 2432 67TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33712-5613
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Country | US
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Telephone | 251-454-1126
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Fax | 727-528-6452
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Provider Business Mailing Address
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Address Line | 2432 67TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33712-5613
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Country | US
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Telephone | 251-454-1126
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Fax | 727-528-6452
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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 | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 24595
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License Number State | AL
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