Individual
PETER ETOH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1401 DIXIE WAY, SANFORD, FL 32771-3034
(407) 415-5064
Mailing address
1401 DIXIE WAY, SANFORD, FL 32771-3034
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
13040
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720418635
—
FL
Enumeration date
08/18/2017
Last updated
06/16/2018
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