Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME139194 | FL |
Y | 111NI0900X | Internist | ME139194 | FL |
NPI | 1003262700 |
---|---|
Provider Name | Dr. Gloria Mavel Velasquez Castano |
First Address | Orlando, FL 32806-1110 |
Second Address | Orlando, FL 32806-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2016 |
Last Update Date | 01/08/2019 |