Provider Demographics
NPI:1558650846
Name:MORILLO, STEFANIA (LMT)
Entity type:Individual
Prefix:MISS
First Name:STEFANIA
Middle Name:
Last Name:MORILLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 SE WALTON LAKES DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3488
Mailing Address - Country:US
Mailing Address - Phone:772-323-7163
Mailing Address - Fax:
Practice Address - Street 1:516 SE WALTON LAKES DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3488
Practice Address - Country:US
Practice Address - Phone:772-323-7163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA58636174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA58636OtherFLORIDA LICENSE