Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | FL |
NPI | 1013503085 |
---|---|
Provider Name | Jose A Colon Valentin |
First Address | Lake Alfred, FL 33850-3910 |
Second Address | Lake Alfred, FL 33850-3910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2020 |
Last Update Date | 15/12/2020 |