Provider Demographics
NPI:1316622749
Name:ORELHOMME, RUBIN
Entity type:Individual
Prefix:MR
First Name:RUBIN
Middle Name:
Last Name:ORELHOMME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 LAKE CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3619
Mailing Address - Country:US
Mailing Address - Phone:407-953-6097
Mailing Address - Fax:
Practice Address - Street 1:725 LAKE CHARLES DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3619
Practice Address - Country:US
Practice Address - Phone:407-953-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL23000133955374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty