Healthcare Provider Details

I. General information

NPI: 1356198519
Provider Name (Legal Business Name): JULISSA MARIA SAENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12315 LAKE UNDERHILL RD
ORLANDO FL
32828-4507
US

IV. Provider business mailing address

5959 LAKE ELLENOR DR
ORLANDO FL
32809-4633
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-4039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: