Healthcare Provider Details

I. General information

NPI: 1962557538
Provider Name (Legal Business Name): EUNIDE VALLON-DESTINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MICHIGAN ST
ORLANDO FL
32805-6203
US

IV. Provider business mailing address

10327 LECON BRANCH CT
ORLANDO FL
32825-7300
US

V. Phone/Fax

Practice location:
  • Phone: 407-317-7430
  • Fax: 407-648-4150
Mailing address:
  • Phone: 321-230-8071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: