Individual
MARYSE DESLOUCHES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
150 SW PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34984-5041
(305) 956-9030
Mailing address
150 SW PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34984-5041
(305) 956-9030
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6907068
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113078100
—
FL
Enumeration date
06/03/2022
Last updated
06/03/2022
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