Provider Demographics
NPI:1578503751
Name:VIDAL, ROSA A (MD)
Entity type:Individual
Prefix:DR
First Name:ROSA
Middle Name:A
Last Name:VIDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2432 67TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-5613
Mailing Address - Country:US
Mailing Address - Phone:251-454-1126
Mailing Address - Fax:727-528-6452
Practice Address - Street 1:2432 67TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-5613
Practice Address - Country:US
Practice Address - Phone:251-454-1126
Practice Address - Fax:727-528-6452
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL245952080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125518Medicaid
FLME135633OtherFLORIDA BOARD OF MEDICINE
AL009981610Medicaid
LA1699098Medicaid
FL263997100Medicaid
AL39-00626OtherUNITED HEALTHCARE
AL51507738OtherBCBS
FL263997100Medicaid
LA1699098Medicaid