Provider Demographics
NPI:1497300602
Name:CARBUNGCO, ESTANISLAO OQUENDO JR
Entity Type:Individual
Prefix:
First Name:ESTANISLAO
Middle Name:OQUENDO
Last Name:CARBUNGCO
Suffix:JR
Gender:M
Credentials:
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 236
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33780-0236
Mailing Address - Country:US
Mailing Address - Phone:727-547-8600
Mailing Address - Fax:727-548-6131
Practice Address - Street 1:10707 66TH ST N STE 14
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-2336
Practice Address - Country:US
Practice Address - Phone:727-547-8600
Practice Address - Fax:727-548-6131
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist