Individual
IRIS JULIETA CHACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCP
Contact information
Practice address
17080 SAFETY ST, FORT MYERS, FL 33908-7506
(239) 223-9094
Mailing address
17080 SAFETY ST, FORT MYERS, FL 33908-7506
(239) 223-9094
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
LP035
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C250410648010
DRIVER LICENSE
FL
Enumeration date
12/09/2020
Last updated
12/09/2020
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