MEDICARE: YAMILE VIDAL ROZAS M.D.

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	2084N0400X	Neurology Physician	57268	FL
2	390200000X	Student in an Organized Health Care Education/Training Program	TRN11118	FL

General Provider Information

NPI Number	:	1164614863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAMILE VIDAL ROZAS M.D.

Provider Business Mailing Address
First Line	:	2933 W COLUMBUS DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-2215
Country	:	US
Telephone Number	:	813-875-2068
Fax Number	:

Provider Business Practice Location Address
First Line	:	2933 W COLUMBUS DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-2215
Country	:	US
Telephone Number	:	813-875-2068
Fax Number	:

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	05/31/2012

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