Individual
MA JOANNA BERGONIA TORRES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1616 OAK AVE, LAKE PLACID, FL 33852-5787
(863) 243-8268
Mailing address
1616 OAK AVE, LAKE PLACID, FL 33852-5787
(863) 243-8268
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
059-834-837
USCIS
FL
Enumeration date
08/18/2016
Last updated
01/02/2017
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