Individual
GUIBRIEL SAMPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3100 SUNSET LANDING DR, JACKSONVILLE, FL 32226-4446
(904) 518-2143
Mailing address
3100 SUNSET LANDING DR, JACKSONVILLE, FL 32226-4446
(904) 518-2143
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
12/19/2016
Last updated
12/19/2016
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