Healthcare Provider Details

I. General information

NPI: 1619925716
Provider Name (Legal Business Name): ANA C OQUENDO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4156 5TH AVE N
SAINT PETERSBURG FL
33713-6304
US

IV. Provider business mailing address

4156 5TH AVE N
SAINT PETERSBURG FL
33713-6304
US

V. Phone/Fax

Practice location:
  • Phone: 727-327-2714
  • Fax: 727-683-9921
Mailing address:
  • Phone: 727-327-2714
  • Fax: 727-683-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME0060595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: