Healthcare Provider Details

I. General information

NPI: 1598900607
Provider Name (Legal Business Name): MARIA CRISTINA POSSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 NE INDIAN RIVER DR AP 1
JENSEN BEACH FL
34957-5206
US

IV. Provider business mailing address

2530 NE INDIAN RIVER DR AP 1
JENSEN BEACH FL
34957-5206
US

V. Phone/Fax

Practice location:
  • Phone: 352-339-3937
  • Fax:
Mailing address:
  • Phone: 352-339-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT 13544
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: