Individual
DR. LORETTA V HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
1508 VILLAGE OAK LN, KISSIMMEE, FL 34746-6558
(407) 518-7747
(407) 518-9009
Mailing address
PO BOX 720849, ORLANDO, FL 32872-0849
(407) 518-7747
(407) 518-9009
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO1685
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029627900
—
FL
01
—
87893
BCBS
FL
Enumeration date
05/12/2006
Last updated
09/13/2016
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