Healthcare Provider Details

I. General information

NPI: 1699331488
Provider Name (Legal Business Name): MARIA T. CARRANZA MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 1ST AVE S
SAINT PETERSBURG FL
33712-1204
US

IV. Provider business mailing address

2621 1ST AVE S
SAINT PETERSBURG FL
33712-1107
US

V. Phone/Fax

Practice location:
  • Phone: 727-289-4747
  • Fax:
Mailing address:
  • Phone: 727-289-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberSU26535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: