Organization
ST JOSEPH'S DIAGNOSTIC CENTER LLC
Active
Other names
BayCare Outpatient Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
TAMBLYN CUBERO (MANAGER)
(727) 281-9390
Entity
Organization
Contact information
Practice address
12780 RACE TRACK RD, SUITE 100, TAMPA, FL 33626-1397
(813) 749-7810
Mailing address
2995 DREW STREET, EAST BLDG 2ND FLOOR, CLEARWATER, FL 33759
(727) 281-9390
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
061048801
—
FL
Enumeration date
06/30/2011
Last updated
01/17/2019
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