Healthcare Provider Details

I. General information

NPI: 1083688915
Provider Name (Legal Business Name): CHARLES J CATINELLA CST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805
US

IV. Provider business mailing address

PO BOX 95004
LAKELAND FL
33804
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-7000
  • Fax: 863-680-7420
Mailing address:
  • Phone: 863-680-7206
  • Fax: 863-680-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number95876
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: