Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist |
NPI | 1164195418 |
---|---|
Provider Name | Kenya Ala |
First Address | Saint Cloud, FL 34772-7467 |
Second Address | Kissimmee, FL 34741-5401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2021 |
Last Update Date | 30/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
108873400 | (05) | FL |
237380 | AHCA - HOMEMAKER COMPANION (01) | FL |