Provider Demographics
NPI:1124564315
Name:MARIA R. VIJIL
Entity Type:Organization
Organization Name:MARIA R. VIJIL
Other - Org Name:ROSIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER FOR PERSONS WITH DISABILIT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ROSARIO
Authorized Official - Last Name:VIJIL
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:727-495-1124
Mailing Address - Street 1:2211 EISENHOWER DR
Mailing Address - Street 2:105
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5600
Mailing Address - Country:US
Mailing Address - Phone:727-495-1124
Mailing Address - Fax:727-848-8198
Practice Address - Street 1:2211 EISENHOWER DR
Practice Address - Street 2:105
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5600
Practice Address - Country:US
Practice Address - Phone:727-495-1124
Practice Address - Fax:727-848-8198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL685783301253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL685783301Medicaid