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General NPI Number Information
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NPI Number | 1578171724
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Entity Type | Organization
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Legal Business Name | IMMUNO PROFESSIONALS PLLC
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 9300 HARRIS CORNERS PKWY STE 160
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City | CHARLOTTE
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State | NC
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Zip | 28269-3791
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Country | US
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Telephone | 704-921-5663
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Fax |
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Provider Business Mailing Address
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Address Line | 9300 HARRIS CORNERS PKWY STE 160
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City | CHARLOTTE
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State | NC
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Zip | 28269-3791
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Country | US
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Telephone | 704-921-5663
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA APPLETON-CASTILLO
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Credential | MD
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Telephone | 704-658-8150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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