Este Logic, P.a. | |
4020 Sun City Center Blvd Suite 11 Sun City Center FL 33573-5285 | |
(813) 634-4700 | |
(813) 634-4703 |
Full Name | Este Logic, P.a. |
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Speciality | Psychologist |
Location | 4020 Sun City Center Blvd, Sun City Center, Florida |
Authorized Official Name and Position | Estela Long (CLINICAL PSYCHOLOGIST) |
Authorized Official Contact | 8137283521 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Este Logic, P.a. 4020 Sun City Center Blvd Suite 11 Sun City Center FL 33573-5285 Ph: (813) 634-4700 | Este Logic, P.a. 4020 Sun City Center Blvd Suite 11 Sun City Center FL 33573-5285 Ph: (813) 634-4700 |
NPI Number | 1417111782 |
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Provider Enumeration Date | 07/15/2008 |
Last Update Date | 08/23/2012 |
Medicare PECOS PAC ID | 8022277326 |
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Medicare Enrollment ID | O20120306000587 |
Identifier | Type | State | Issuer |
---|---|---|---|
1417111782 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | PY6533 (Florida) | Primary |
Provider Name | Estela M Long |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1700924826 PECOS PAC ID: 0143234062 Enrollment ID: I20060131000334 |
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