Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | PA9110739 | FL |
NPI | 1992215420 |
---|---|
Provider Name | Cassandra Leigh Klebous |
First Address | Orlando, FL 32832-5934 |
Second Address | Orlando, FL 32827-7402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2017 |
Last Update Date | 11/10/2017 |