Individual
AMICA LERTKITCHAROENPON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1849 FOROUGH CIR, PORT ORANGE, FL 32128-6023
(386) 451-1450
Mailing address
1849 FOROUGH CIR, PORT ORANGE, FL 32128-6023
(386) 451-1450
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/25/2026
Last updated
03/25/2026
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