Provider Demographics
NPI:1396192175
Name:JOSOL, PETE
Entity Type:Individual
Prefix:
First Name:PETE
Middle Name:
Last Name:JOSOL
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 1:1316 SANTA ROSA DR APT 304
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7576
Mailing Address - Country:US
Mailing Address - Phone:863-513-3944
Mailing Address - Fax:
Practice Address - Street 1:1316 SANTA ROSA DR APT 304
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7576
Practice Address - Country:US
Practice Address - Phone:863-513-3944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist