MEDICARE: AMABEL LATORRE-RODRIGUEZ LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA 54842	FL

General Provider Information

NPI Number	:	1144475237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMABEL LATORRE-RODRIGUEZ LMT

Provider Business Mailing Address
First Line	:	3210 W COLUMBUS DR
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33607-1818
Country	:	US
Telephone Number	:	813-876-7812
Fax Number	:	813-374-2214

Provider Business Practice Location Address
First Line	:	3210 W COLUMBUS DR
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33607-1818
Country	:	US
Telephone Number	:	813-876-7812
Fax Number	:	813-374-2214

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	02/04/2009

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