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Individual

MR. IVAN LOPEZLLAVORE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
3011 SABAL BEND DR NE, WINTER HAVEN, FL 33881-5108
(863) 651-3040
Mailing address
3210 WHISPERING TRAILS AVE, WINTER HAVEN, FL 33884-1826
(863) 651-3040

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
PTA20203
FL
314000000X
Skilled Nursing Facility
Primary
PTA20203
FL
376G00000X
Nursing Home Administrator
NH4843
FL

Other

Enumeration date
07/06/2009
Last updated
09/20/2024
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