Organization
PASADENA ENT PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROY SPENCE (OFFICE MANAGER)
(727) 341-0551
Entity
Organization
Contact information
Practice address
6827 FIRST AVENUE SOUTH, SUITE 100, ST PETERSBURG, FL 33707-4516
(727) 341-0551
(727) 341-0332
Mailing address
6827 FIRST AVENUE SOUTH, SUITE 100, ST PETERSBURG, FL 33707-4516
(727) 341-0551
(727) 341-0332
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME82762
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261879600
—
FL
Enumeration date
07/22/2006
Last updated
06/20/2014
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