Provider Demographics
NPI:1992296081
Name:CONDE, LUIS (BSW)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:CONDE
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 E VINE ST STE 204
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-386-3344
Practice Address - Street 1:1633 E VINE ST STE 204
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3736
Practice Address - Country:US
Practice Address - Phone:407-329-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator