Healthcare Provider Details

I. General information

NPI: 1225234347
Provider Name (Legal Business Name): SAMUEL PAUL WIRICK-VELEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SAMUEL PAUL WIRICK

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 WHATLEY BLVD
SEBRING FL
33872-3768
US

IV. Provider business mailing address

221 WHATLEY BLVD
SEBRING FL
33872-3768
US

V. Phone/Fax

Practice location:
  • Phone: 863-214-5256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: