Individual
WANDA D GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
740 LORTIE AVE, MALABAR, FL 32950-4919
(321) 674-3947
Mailing address
740 LORTIE AVE, MALABAR, FL 32950-4919
(321) 674-3947
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
02/11/2019
Last updated
02/11/2019
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