Provider Demographics
NPI:1407208259
Name:OPIAH, DUPE
Entity Type:Individual
Prefix:
First Name:DUPE
Middle Name:
Last Name:OPIAH
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 1:1233 APOPKA LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-5018
Mailing Address - Country:US
Mailing Address - Phone:561-315-4133
Mailing Address - Fax:863-427-3145
Practice Address - Street 1:1233 APOPKA LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-5018
Practice Address - Country:US
Practice Address - Phone:561-512-7981
Practice Address - Fax:863-427-6314
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL650036411251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health