Individual
GUILAINE DESTRAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1313 E FLETCHER AVE, TAMPA, FL 33612-3629
(301) 266-7290
Mailing address
3350 W HILLSBOROUGH AVE, APT 1218, TAMPA, FL 33614-1309
(301) 266-7290
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
428798
MD
1744P3200X
Prosthetics Case Management
Primary
CL1242744
FL
Other
Enumeration date
09/19/2016
Last updated
09/19/2016
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