Individual
MARGARITA CUSTODIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
236 E IDLEWILD AVE, EUSTIS, FL 32726-6456
(352) 702-7483
Mailing address
236 E IDLEWILD AVE, EUSTIS, FL 32726-6456
(352) 702-7483
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
603613
—
FL
Enumeration date
11/04/2015
Last updated
11/04/2015
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