Healthcare Provider Details

I. General information

NPI: 1487023545
Provider Name (Legal Business Name): VIRTUDES PUELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 SWEETWATER BLVD
SAINT CLOUD FL
34772-8605
US

IV. Provider business mailing address

2323 SWEETWATER BLVD
SAINT CLOUD FL
34772-8605
US

V. Phone/Fax

Practice location:
  • Phone: 407-879-8755
  • Fax:
Mailing address:
  • Phone: 407-879-8755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: