MEDICARE: ROSIBEL MOLINA PERURENA M A

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	173000000X	Legal Medicine	MA 53397	FL

General Provider Information

NPI Number	:	1275799934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSIBEL MOLINA PERURENA M A

Provider Business Mailing Address
First Line	:	3260 W HILLSBOROUGH AVE
Second Line	:	# 111
City	:	TAMPA
State	:	FL
Zip	:	33614-5902
Country	:	US
Telephone Number	:	813-873-9369
Fax Number	:	813-873-9386

Provider Business Practice Location Address
First Line	:	3260 W HILLSBOROUGH AVE
Second Line	:	# 111
City	:	TAMPA
State	:	FL
Zip	:	33614-5902
Country	:	US
Telephone Number	:	813-873-9369
Fax Number	:	813-873-9386

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

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	08/01/2008

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