Provider Demographics
NPI:1770148819
Name:DE LA ROSA, MARGARITA (CBHCM)
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 W SAINT ISABEL ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6382
Mailing Address - Country:US
Mailing Address - Phone:813-769-9571
Mailing Address - Fax:813-492-8843
Practice Address - Street 1:2706 W SAINT ISABEL ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6382
Practice Address - Country:US
Practice Address - Phone:813-769-9571
Practice Address - Fax:813-492-8843
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136186207R00000X, 208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice