Provider Demographics
NPI:1164614863
Name:ROZAS, YAMILE VIDAL (MD)
Entity Type:Individual
Prefix:
First Name:YAMILE
Middle Name:VIDAL
Last Name:ROZAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YAMILE
Other - Middle Name:ENID
Other - Last Name:VIDAL SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2933 W COLUMBUS DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2215
Mailing Address - Country:US
Mailing Address - Phone:813-875-2068
Mailing Address - Fax:
Practice Address - Street 1:2933 W COLUMBUS DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2215
Practice Address - Country:US
Practice Address - Phone:813-875-2068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL572682084N0400X
FLTRN11118390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program