Organization
TITUSVILLE NEUROLOGY LLC
Active
Organization
TITUSVILLE NEUROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEILA MARIA PATALLO M.D. (OWNER/PHYSICIAN)
(321) 383-0900
Entity
Organization
Contact information
Practice address
123 S PARK AVE, TITUSVILLE, FL 32796-3377
(321) 383-0900
(321) 383-0024
Mailing address
123 S PARK AVE, TITUSVILLE, FL 32796-3377
(321) 383-0900
(321) 383-0024
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13868
BLUE CROSS BLUE SHIELD
FL
Enumeration date
12/16/2013
Last updated
01/27/2014
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