Individual
JOSETTE TELISIER ALTIDOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ADMINISTRATOR /OWNER
Contact information
Practice address
541 BRENTFORD CT, KISSIMMEE, FL 34758
(734) 788-9020
Mailing address
541 BRENTFORD CT, KISSIMMEE, FL 34758-4119
(734) 788-9020
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
AL12988
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020676200
—
FL
Enumeration date
08/23/2017
Last updated
07/21/2022
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