Provider Demographics
NPI:1770043507
Name:VINENT CARBONELL, CELENA (MD)
Entity Type:Individual
Prefix:
First Name:CELENA
Middle Name:
Last Name:VINENT CARBONELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 N MCMULLEN BOOTH RD STE 303
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2022
Mailing Address - Country:US
Mailing Address - Phone:727-725-6110
Mailing Address - Fax:727-669-9742
Practice Address - Street 1:5721 RICHEY DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6057
Practice Address - Country:US
Practice Address - Phone:727-807-9754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1260208D00000X, 261QP2300X
PR21476208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care