Provider Demographics
NPI:1134302748
Name:AGNES UBANI INC
Entity Type:Organization
Organization Name:AGNES UBANI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:UBANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-341-7900
Mailing Address - Street 1:PO BOX 16722
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33687-6722
Mailing Address - Country:US
Mailing Address - Phone:813-341-7900
Mailing Address - Fax:
Practice Address - Street 1:10320 N 56TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-4071
Practice Address - Country:US
Practice Address - Phone:813-341-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 84332261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7030Medicare PIN