MEDICARE: ROSA I ROSARIO ORTIZ CNA/MED TECHNICIAN

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	251E00000X	Home Health Agency	183406	FL

General Provider Information

NPI Number	:	1598447484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA I ROSARIO ORTIZ CNA/MED TECHNICIAN

Provider Business Mailing Address
First Line	:	3520 CLEVELAND HEIGHTS BLVD APT 129
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-4877
Country	:	US
Telephone Number	:	863-608-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 CLEVELAND HEIGHTS BLVD APT 129
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-4877
Country	:	US
Telephone Number	:	863-608-0222
Fax Number	:

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

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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Directions to “ ROSA I ROSARIO ORTIZ CNA/MED TECHNICIAN” Practice Location

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