Provider Demographics
NPI:1295072981
Name:REBELO, DORA G
Entity type:Individual
Prefix:MRS
First Name:DORA
Middle Name:G
Last Name:REBELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16825 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32820-1910
Mailing Address - Country:US
Mailing Address - Phone:407-568-5065
Mailing Address - Fax:407-568-1803
Practice Address - Street 1:16825 EAST COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32820
Practice Address - Country:US
Practice Address - Phone:407-568-5065
Practice Address - Fax:407-568-1803
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist