Healthcare Provider Details

I. General information

NPI: 1366698078
Provider Name (Legal Business Name): ALL WOMEN'S HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 CENTRAL AVE
ST PETERSBURG FL
33713-8229
US

IV. Provider business mailing address

2106 DREW ST SUITE 103
CLEARWATER FL
33765-3238
US

V. Phone/Fax

Practice location:
  • Phone: 800-736-6656
  • Fax: 727-321-8433
Mailing address:
  • Phone: 727-442-0445
  • Fax: 727-447-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number838
License Number StateFL

VIII. Authorized Official

Name: MARISELLA MARENGO
Title or Position: CONTRACT AND BILLING MANAGER
Credential:
Phone: 727-442-0445