Individual
JUAN CARLOS FONTANEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2005 GRANDE CT APT 902, KISSIMMEE, FL 34743-3130
(939) 313-8920
Mailing address
PRESERVERS OF DESTINIES, 1621 E. VINE ST, KISSIMMEE, FL 34744
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
10/26/2022
Last updated
10/27/2022
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