Provider Demographics
NPI:1821195058
Name:VICTORIA RABE-TAGALA, M.D., P.A.
Entity Type:Organization
Organization Name:VICTORIA RABE-TAGALA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RABE-TAGALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-646-7754
Mailing Address - Street 1:3885 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1109
Mailing Address - Country:US
Mailing Address - Phone:863-646-7754
Mailing Address - Fax:863-644-0147
Practice Address - Street 1:3885 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1109
Practice Address - Country:US
Practice Address - Phone:863-646-7754
Practice Address - Fax:863-644-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 00287222081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53591OtherBC FL
FL0668460000Medicaid
250005388OtherRAILROAD MC
250005388OtherRAILROAD MC
250005388OtherRAILROAD MC