Healthcare Provider Details

I. General information

NPI: 1003924671
Provider Name (Legal Business Name): DIANA ESTORINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 49TH ST N SUITE 202
ST PETERSBURG FL
33709-2146
US

IV. Provider business mailing address

PO BOX 20072
TAMPA FL
33622-0072
US

V. Phone/Fax

Practice location:
  • Phone: 727-520-1500
  • Fax: 727-520-1588
Mailing address:
  • Phone: 727-520-1500
  • Fax: 727-520-1588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: DIANA ESTORINO
Title or Position: OWNER
Credential: B.A., R.NCST, R.EEG/
Phone: 727-520-1500