Provider Demographics
NPI:1396371936
Name:ABAUNZA, ANDREA ALEJANDRA (AP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ALEJANDRA
Last Name:ABAUNZA
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46062
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0101
Mailing Address - Country:US
Mailing Address - Phone:813-345-7559
Mailing Address - Fax:
Practice Address - Street 1:10971 COUNTRYWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2630
Practice Address - Country:US
Practice Address - Phone:813-345-7559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4116171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty