Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | OS8839 | FL |
NPI | 1265420723 |
---|---|
Provider Name | Kalpana S Depasquale |
First Address | St Augustine, FL 32085-3123 |
Second Address | St Augustine, FL 32080-3108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 08/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
267562500 | (05) | FL |
H95469 | (02) |