Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1588829550 |
---|---|
Provider Name | Ms. Denise Irish |
First Address | Valrico, FL 33594 |
Second Address | Valrico, FL 33596-8494 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2008 |
Last Update Date | 18/07/2008 |