Individual
JOSE ENRIQUE COSME GRULLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3201 BUDINGER AVE, SAINT CLOUD, FL 34769-7203
(407) 891-3054
(888) 477-7678
Mailing address
12124 CALABOOSE CT, ORLANDO, FL 32828-8977
(939) 358-7056
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
11418
PR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
08/07/2018
Last updated
08/07/2018
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