Basic Information
| Provider Information | |||||||||
| NPI: | 1497300602 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARBUNGCO | ||||||||
| FirstName: | ESTANISLAO | ||||||||
| MiddleName: | OQUENDO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 236 | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337800236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275478600 | ||||||||
| FaxNumber: | 7275486131 | ||||||||
| Practice Location | |||||||||
| Address1: | 10707 66TH ST N STE 14 | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337822336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275478600 | ||||||||
| FaxNumber: | 7275486131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2019 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.