Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO 5580 | ZZ |
NPI | 1083026835 |
---|---|
Provider Name | Selenne Rubi Garnelo |
First Address | St Petersburg, FL 33714-3722 |
Second Address | Zephyrhills, FL 33541-4371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 28/05/2014 |