Healthcare Provider Details

I. General information

NPI: 1861252769
Provider Name (Legal Business Name): KEILA A CUMARE CHIRINOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S HIAWASSEE RD
ORLANDO FL
32835-6317
US

IV. Provider business mailing address

3200 S HIAWASSEE RD
ORLANDO FL
32835-6317
US

V. Phone/Fax

Practice location:
  • Phone: 407-286-4031
  • Fax: 407-286-4158
Mailing address:
  • Phone: 407-286-4031
  • Fax: 407-286-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: