Individual
LAURA XILENA IDARRAGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
207 DENNISON RD, LUTZ, FL 33548-4576
(813) 510-7415
Mailing address
207 DENNISON RD, LUTZ, FL 33548-4576
(813) 510-7415
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
I362539998480
FL
Other
Enumeration date
01/09/2021
Last updated
01/09/2021
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