Individual
JAQUELINE PICHARDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 PLACETAS CT, KISSIMMEE, FL 34743-3337
(407) 247-1292
Mailing address
2401 PLACETAS CT, KISSIMMEE, FL 34743-3337
(407) 247-1292
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1813900901704
STATE ID
PA
Enumeration date
11/10/2018
Last updated
11/10/2018
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