Healthcare Provider Details

I. General information

NPI: 1497104483
Provider Name (Legal Business Name): PATRICIA PRIETO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13584 CRYSTAL RIVER DR
ORLANDO FL
32828-8443
US

IV. Provider business mailing address

13584 CRYSTAL RIVER DR
ORLANDO FL
32828-8443
US

V. Phone/Fax

Practice location:
  • Phone: 407-923-7682
  • Fax:
Mailing address:
  • Phone: 407-923-7682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: