Provider Demographics
NPI:1386993426
Name:GORUT, CELINA
Entity type:Individual
Prefix:
First Name:CELINA
Middle Name:
Last Name:GORUT
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 1:440 SAWGRASS CORPORATE PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6236
Mailing Address - Country:US
Mailing Address - Phone:954-727-0821
Mailing Address - Fax:
Practice Address - Street 1:440 SAWGRASS CORPORATE PKWY STE 106
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33325-6236
Practice Address - Country:US
Practice Address - Phone:954-727-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG630100818110251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health