Individual
ELIA ENIS MARRERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1631 E VINE ST STE J, KISSIMMEE, FL 34744-3728
(407) 329-3464
Mailing address
835 BERWICK DR, DAVENPORT, FL 33897-8308
(787) 424-4118
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171MOOOOOX
—
FL
Enumeration date
09/13/2018
Last updated
09/13/2018
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