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Individual

JABBAR DEMOND BRANCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
BA

Contact information

Practice address
523 WEKIVA COMMONS CIR # 4, APOPKA, FL 32712-3645
(407) 464-2111
Mailing address
523 WEKIVA COMMONS CIR # 4, APOPKA, FL 32712-3645
(407) 464-2111

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
B652424823070
DRIVER'S LICENSE
FL
Enumeration date
01/08/2013
Last updated
01/08/2013
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