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General NPI Number Information
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NPI Number | 1073984365
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Entity Type | Individual
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Provider Name | KARUNASREE GOGINENI P.A-C
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Gender | Female
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 14171 METROPOLIS AVE SUITE 200
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City | FORT MYERS
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State | FL
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Zip | 33912-4335
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Country | US
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Telephone | 239-561-2202
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Fax |
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Provider Business Mailing Address
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Address Line | 8293 SILVER BIRCH WAY
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City | LEHIGH ACRES
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State | FL
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Zip | 33971-3721
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Country | US
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Telephone | 239-938-4168
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9109142
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License Number State | FL
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