Individual
MARIE MODE ATILUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10650 W STATE ROAD 84 STE 206, DAVIE, FL 33324-4235
(954) 634-3636
(954) 634-3637
Mailing address
1460 NW 20TH ST, FORT LAUDERDALE, FL 33311-3524
(954) 864-4602
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022152400
—
FL
Enumeration date
10/02/2017
Last updated
10/02/2017
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