Individual
MONICA MARLENE VIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2904 PONCE CREST DR, SAINT CLOUD, FL 34772-8955
(689) 210-9602
Mailing address
2904 PONCE CREST DR, SAINT CLOUD, FL 34772-8955
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
FL
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
07/27/2021
Last updated
09/07/2022
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