Provider Demographics
NPI:1205475761
Name:ST PETERSBURG SKIN AND LASER CENTER LLC
Entity type:Organization
Organization Name:ST PETERSBURG SKIN AND LASER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATARINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KESTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-474-4938
Mailing Address - Street 1:100 40TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-6125
Mailing Address - Country:US
Mailing Address - Phone:727-474-9399
Mailing Address - Fax:202-436-9358
Practice Address - Street 1:100 40TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-6125
Practice Address - Country:US
Practice Address - Phone:727-474-9399
Practice Address - Fax:202-436-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty