Individual
SAMUEL PIERRELOUIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3708 CONWAY RD, ORLANDO, FL 32812-7608
(310) 292-2830
Mailing address
PO BOX 617474, ORLANDO, FL 32861-7474
(310) 292-2830
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2632
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004840900
—
FL
Enumeration date
10/17/2016
Last updated
10/17/2016
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