Healthcare Provider Details

I. General information

NPI: 1669637823
Provider Name (Legal Business Name): JOSE KUILAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2008
Last Update Date: 07/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 INTERNATIONAL DR
ORLANDO FL
32819-8261
US

IV. Provider business mailing address

6201 INTERNATIONAL DR
ORLANDO FL
32819-8261
US

V. Phone/Fax

Practice location:
  • Phone: 407-345-8402
  • Fax:
Mailing address:
  • Phone: 407-345-8402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS0022719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: