Healthcare Provider Details

I. General information

NPI: 1336553817
Provider Name (Legal Business Name): SETENOV ENTERPRISE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9702 UNIVERSAL BLVD B-325
ORLANDO FL
32819-8721
US

IV. Provider business mailing address

9702 UNIVERSAL BLVD B-325
ORLANDO FL
32819-8721
US

V. Phone/Fax

Practice location:
  • Phone: 470-505-9158
  • Fax: 866-480-9482
Mailing address:
  • Phone: 470-505-9158
  • Fax: 866-480-9482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 8996
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY 8996
License Number StateFL

VIII. Authorized Official

Name: DR. ALFRED DEAN VONETES
Title or Position: PRESIDENT/CEO
Credential: PSY.D
Phone: 407-505-9158