Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1114407566 |
---|---|
Provider Name | Ralph Juliano |
First Address | Ocala, FL 34471-9140 |
Second Address | Ocala, FL 34471-9140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2018 |
Last Update Date | 15/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PRO16 | STATE OF FL (01) | FL |