MEDICARE: DR. YVETTE ROSA DC

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	111N00000X	Chiropractor	CH 7791	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55900	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1821121062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YVETTE ROSA DC

Provider Business Mailing Address
First Line	:	13902 N DALE MABRY HWY STE 134
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2441
Country	:	US
Telephone Number	:	813-363-8964
Fax Number	:	813-968-7999

Provider Business Practice Location Address
First Line	:	13902 N DALE MABRY HWY STE 134
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2441
Country	:	US
Telephone Number	:	813-363-8964
Fax Number	:	813-968-7999

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/21/2022

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Directions to “ DR. YVETTE ROSA DC” Practice Location

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