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General NPI Number Information
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NPI Number | 1992094098
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Entity Type | Individual
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Provider Name | MR. YVAN POMPILUS
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Gender | Male
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 5150 NW MILNER DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-3392
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Country | US
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Telephone | 772-462-3828
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Fax | 772-429-2016
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Provider Business Mailing Address
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Address Line | 5150 NW MILNER DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-3392
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Country | US
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Telephone | 772-462-3828
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Fax | 772-429-2016
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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