Healthcare Provider Details

I. General information

NPI: 1306543277
Provider Name (Legal Business Name): ENLLY CAROLINA OCANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 HAMMOCK RIDGE RD APT 6102
CLERMONT FL
34711-6385
US

IV. Provider business mailing address

1480 HAMMOCK RIDGE RD APT 6102
CLERMONT FL
34711-6385
US

V. Phone/Fax

Practice location:
  • Phone: 201-686-0869
  • Fax:
Mailing address:
  • Phone: 201-686-0869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: