Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 103TC1900X | Counseling Psychologist |
NPI | 1114384906 |
---|---|
Provider Name | Mr. Juan Eno Pimentel SR. |
First Address | Tampa, FL 33618-1857 |
Second Address | Tampa, FL 33618-1857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2016 |
Last Update Date | 25/01/2016 |