Healthcare Provider Details

I. General information

NPI: 1891022992
Provider Name (Legal Business Name): RONI ROMEO TUMALON OCUBILLO OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W COMMERCIAL BLVD STE 116
FORT LAUDERDALE FL
33309-3444
US

IV. Provider business mailing address

3201 W COMMERCIAL BLVD STE 116
FORT LAUDERDALE FL
33309-3444
US

V. Phone/Fax

Practice location:
  • Phone: 954-332-4465
  • Fax: 866-422-3851
Mailing address:
  • Phone: 954-332-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number003513
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: