Organization
ST JOSEPH'S DIAGNOSTIC CENTER LLC
Active
Other names
BayCare Outpatient Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
TAMBLYN CUBERO (VP)
(727) 281-9093
Entity
Organization
Contact information
Practice address
17512 DONA MICHELLE DR STE 5, TAMPA, FL 33647-3265
(813) 586-7650
Mailing address
2995 DREW ST FL 2, CLEARWATER, FL 33759-3012
(727) 281-9065
(813) 635-2613
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
061048806
—
FL
Enumeration date
06/07/2017
Last updated
01/18/2019
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