Individual
LILIYA HERETSUN-ROUSSONICOLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1488 SE VILLAGE GREEN DR, PORT ST LUCIE, FL 34952-3411
(722) 301-1497
(321) 676-8508
Mailing address
1488 SE VILLAGE GREEN DR, PORT ST LUCIE, FL 34952-3411
(772) 777-4745
(772) 777-4833
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
FL
Other
Enumeration date
07/15/2020
Last updated
10/09/2020
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