Individual provider · NPI-1
Luis Antonio Rosa Jr.
Contractor · Valrico, FL
NPI number1114452919
StatusActive
Last updated in NPPESApr 29, 2017
Details
- NPI
- 1114452919
- Entity type
- Individual (NPI-1)
- Name
- Luis Antonio Rosa Jr.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 29, 2017
- Last updated
- Apr 29, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171W00000X | Contractor | – | – | Yes |
Practice location
2114 Ridgemore DrValrico, FL 33594-3200
Phone 941-586-3031
Mailing address
2114 Ridgemore DrValrico, FL 33594-3200
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