Healthcare Provider Details

I. General information

NPI: 1750044392
Provider Name (Legal Business Name): CIPRIAN MIHAIL PUFULETE CPED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 VALLEYGATE DR STE 101A
FAYETTEVILLE NC
28304-3666
US

IV. Provider business mailing address

25 AMARILLO LN
SANFORD NC
27332-3018
US

V. Phone/Fax

Practice location:
  • Phone: 919-500-3264
  • Fax: 919-343-1937
Mailing address:
  • Phone: 919-343-1982
  • Fax: 919-343-1937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC50032
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC50032
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: