Provider Demographics
NPI:1164924064
Name:PUJOL, MARCOS L ALVARES
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:L ALVARES
Last Name:PUJOL
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 1:13304 STONEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-4457
Mailing Address - Country:US
Mailing Address - Phone:321-200-9384
Mailing Address - Fax:321-200-9384
Practice Address - Street 1:498 PALM SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7829
Practice Address - Country:US
Practice Address - Phone:407-388-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27934225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant