Healthcare Provider Details

I. General information

NPI: 1295958940
Provider Name (Legal Business Name): ANGELINA L VALCOS-SARAU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 E FOWLER AVE
TAMPA FL
33617-2026
US

IV. Provider business mailing address

3305 W CORONA ST
TAMPA FL
33629-8031
US

V. Phone/Fax

Practice location:
  • Phone: 800-282-6613
  • Fax: 813-972-8267
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberME 82021
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: