Provider Demographics
NPI:1699249763
Name:FIGUEROA, KENELMA
Entity type:Individual
Prefix:
First Name:KENELMA
Middle Name:
Last Name:FIGUEROA
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 1:3700 CURRY FORD RD APT R5
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2637
Mailing Address - Country:US
Mailing Address - Phone:787-519-1515
Mailing Address - Fax:
Practice Address - Street 1:3700 CURRY FORD RD APT R5
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2637
Practice Address - Country:US
Practice Address - Phone:787-519-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF266500697030OtherDRIVERS LICENSE