Individual
MISS IRELIAM GUADALUPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
10501 FGCU BLVD S, FORT MYERS, FL 33965-5588
(239) 745-4299
Mailing address
12801 EAGLE POINTE CIR, FORT MYERS, FL 33913-7964
(239) 340-9111
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL2555
FL
Other
Enumeration date
02/14/2008
Last updated
11/21/2019
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