Provider Demographics
NPI:1841760360
Name:MIRZA, RUBINA SHAHEEN
Entity Type:Individual
Prefix:
First Name:RUBINA
Middle Name:SHAHEEN
Last Name:MIRZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CPAP
Other - Middle Name:CENTRAL
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14049 LEMON VALLEY PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3160
Mailing Address - Country:US
Mailing Address - Phone:813-401-7633
Mailing Address - Fax:
Practice Address - Street 1:14049 LEMON VALLEY PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3160
Practice Address - Country:US
Practice Address - Phone:813-401-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL18000268572332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$Medicaid