Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 11015333 | FL |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 11015333 | FL |
NPI | 1013687904 |
---|---|
Provider Name | Guadalupe Sulbaran |
First Address | Doral, FL 33178-2081 |
Second Address | Miami, FL 33176-2178 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2021 |
Last Update Date | 11/10/2021 |