Provider Demographics
NPI:1275799934
Name:MOLINA PERURENA, ROSIBEL (M A)
Entity Type:Individual
Prefix:
First Name:ROSIBEL
Middle Name:
Last Name:MOLINA PERURENA
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 W HILLSBOROUGH AVE
Mailing Address - Street 2:# 111
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5902
Mailing Address - Country:US
Mailing Address - Phone:813-873-9369
Mailing Address - Fax:813-873-9386
Practice Address - Street 1:3260 W HILLSBOROUGH AVE
Practice Address - Street 2:# 111
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5902
Practice Address - Country:US
Practice Address - Phone:813-873-9369
Practice Address - Fax:813-873-9386
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 53397173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine