Healthcare Provider Details

I. General information

NPI: 1083253108
Provider Name (Legal Business Name): PAMELA PAOLA URENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 LIVE OAK BLVD STE B
SAINT CLOUD FL
34771-8410
US

IV. Provider business mailing address

155 COLUMBIA DR
KISSIMMEE FL
34759-5961
US

V. Phone/Fax

Practice location:
  • Phone: 321-805-4756
  • Fax:
Mailing address:
  • Phone: 407-201-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: