Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA25110 | FL |
NPI | 1447563879 |
---|---|
Provider Name | Lisa Martino |
First Address | Tarpon Springs, FL 34689-3460 |
Second Address | Tarpon Springs, FL 34689-4362 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2010 |
Last Update Date | 08/05/2012 |