Healthcare Provider Details

I. General information

NPI: 1760435507
Provider Name (Legal Business Name): IULIA FUNIERU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497 LEGENDS BLVD
CHAMPIONS GATE FL
33896-8393
US

IV. Provider business mailing address

1497 LEGENDS BLVD
CHAMPIONS GATE FL
33896-8393
US

V. Phone/Fax

Practice location:
  • Phone: 407-479-2924
  • Fax: 407-479-2999
Mailing address:
  • Phone: 407-479-2924
  • Fax: 407-479-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME84704
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME84704
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: