Provider Demographics
NPI:1598715492
Name:TURALBA, CORNELIUS C (MD)
Entity Type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:C
Last Name:TURALBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 WEST VIRGINIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6327
Mailing Address - Country:US
Mailing Address - Phone:813-662-6024
Mailing Address - Fax:813-514-1257
Practice Address - Street 1:6215 21ST AVE W
Practice Address - Street 2:SUITE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7819
Practice Address - Country:US
Practice Address - Phone:941-795-2270
Practice Address - Fax:941-795-7995
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME474362085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044535500Medicaid
FL41248OtherBCBS
FL276514400Medicaid
FLP00898041OtherRR MEDICARE
FL276514400Medicaid
FL41248OtherBCBS
AC167Medicare PIN
FLD54747Medicare UPIN
41248XMedicare PIN
FL41248UMedicare PIN