Individual
VIRGINIA MILAGROS BOURET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4444 S RIO GRANDE AVE APT 210B, ORLANDO, FL 32839-1114
(407) 501-1135
Mailing address
4444 S RIO GRANDE AVE APT 210B, ORLANDO, FL 32839-1114
(407) 501-1135
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B63087355680
DRIVERS LICENSE
FL
Enumeration date
05/30/2018
Last updated
06/16/2018
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