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FREDDY GLENN FEIDANGA TEMODEA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
4795 MIRAGE BAY CIR, UNIT 303, FORT MYERS, FL 33966-6656
(646) 474-4776
Mailing address
4795 MIRAGE BAY CIR, UNIT 303, FORT MYERS, FL 33966-6656
(646) 474-4776

Taxonomy

Speciality
Code
Description
License number
State
374700000X
Technician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
102274800
FL
Enumeration date
02/01/2022
Last updated
02/01/2022
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