Individual
REGINALD PERNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1650 HOWLAND BLVD, DELTONA, FL 32738-5318
(352) 364-3475
Mailing address
1650 HOWLAND BLVD, DELTONA, FL 32738-5318
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
P654-733-64--144-0
FL
Other
Enumeration date
08/23/2019
Last updated
08/23/2019
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