Provider Demographics
NPI:1568431419
Name:ROSA SOLA, MABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MABEL
Middle Name:
Last Name:ROSA SOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:20 E MELBOURNE AVE STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5970
Practice Address - Country:US
Practice Address - Phone:321-312-1167
Practice Address - Fax:321-312-1201
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14932208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBR8465874OtherDEA
PR0021905Medicare PIN
PRH96589Medicare UPIN