Organization
PURAVITA IV LOUNGE, LLC
Active
Other names
CDF Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARLA DARNETT FUENTES-BLANCO APRN (CEO)
(407) 212-0860
Entity
Organization
Contact information
Practice address
890 LIVESTOCK LOOP, SAINT CLOUD, FL 34771-9146
(407) 212-0860
Mailing address
890 LIVESTOCK LOOP, SAINT CLOUD, FL 34771-9146
(407) 212-0860
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
—
—
Other
Enumeration date
09/03/2024
Last updated
09/03/2024
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