Provider Demographics
NPI:1184971467
Name:NEUROLOGY CLINIC OF TAMPA LLC
Entity type:Organization
Organization Name:NEUROLOGY CLINIC OF TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAMILE
Authorized Official - Middle Name:VIDAL
Authorized Official - Last Name:ROZAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-480-9815
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:813-350-9040
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:813-350-9040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1101452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty