Healthcare Provider Details

I. General information

NPI: 1407208259
Provider Name (Legal Business Name): DUPE OPIAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 APOPKA LN
KISSIMMEE FL
34759-5018
US

IV. Provider business mailing address

1233 APOPKA LN
KISSIMMEE FL
34759-5018
US

V. Phone/Fax

Practice location:
  • Phone: 561-512-7981
  • Fax: 863-427-6314
Mailing address:
  • Phone: 561-315-4133
  • Fax: 863-427-3145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number650036411
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: