Individual
MR. JEAN A CLERSAINVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3615 SW 52ND AVE APT B203, PEMBROKE PARK, FL 33023-6942
(754) 703-1812
Mailing address
3615 SW 52ND AVE APT B203, PEMBROKE PARK, FL 33023-6942
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
C462461752650
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
842464757
C-CLASS TRANSPORT
FL
Enumeration date
05/12/2020
Last updated
05/12/2020
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