Healthcare Provider Details

I. General information

NPI: 1922232776
Provider Name (Legal Business Name): LAURA CSERE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 W KENNEDY BLVD STE 600
TAMPA FL
33609-2584
US

IV. Provider business mailing address

4830 W KENNEDY BLVD STE 600
TAMPA FL
33609-2584
US

V. Phone/Fax

Practice location:
  • Phone: 813-992-6620
  • Fax: 804-999-0464
Mailing address:
  • Phone: 813-992-6620
  • Fax: 804-999-0464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberOS14305
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: