Healthcare Provider Details

I. General information

NPI: 1578019881
Provider Name (Legal Business Name): CLAUDIA CIFUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2016
Last Update Date: 08/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 S DALE MABRY HWY STE. 201
TAMPA FL
33629-5019
US

IV. Provider business mailing address

1220 S DALE MABRY HWY STE. 201
TAMPA FL
33629-5019
US

V. Phone/Fax

Practice location:
  • Phone: 813-258-8887
  • Fax: 813-925-4351
Mailing address:
  • Phone: 813-258-8887
  • Fax: 813-925-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: