Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 11580 | FL |
NPI | 1043831092 |
---|---|
Provider Name | Ines Matilde Garrido |
First Address | Clermont, FL 34711-7647 |
Second Address | The Villages, FL 32162-5385 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2020 |
Last Update Date | 30/04/2020 |