Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | OS138898 | FL |
Y | 2081P2900X | Pain Medicine | OS13898 | FL |
NPI | 1407122468 |
---|---|
Provider Name | Jessica G Cupido |
First Address | Zephyrhills, FL 33542-7505 |
Second Address | Brandon, FL 33511-2906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2012 |
Last Update Date | 29/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023320500 | (05) | FL |