Individual
DAISY LOMADILLA BOYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11703 HOLLY CREEK DR, RIVERVIEW, FL 33569-3356
(813) 389-4118
Mailing address
11703 HOLLY CREEK DR, RIVERVIEW, FL 33569
(813) 389-4118
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
FL
332900000X
Non-Pharmacy Dispensing Site
L534-173-81-942-0
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L534-173-81-942-0
TEACHER
FL
Enumeration date
08/31/2020
Last updated
12/11/2020
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