Provider Demographics
NPI:1558987123
Name:AIL, ADRIAN EDUARDO
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:EDUARDO
Last Name:AIL
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 1:27 LEGEND HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1370
Mailing Address - Country:US
Mailing Address - Phone:281-912-4053
Mailing Address - Fax:
Practice Address - Street 1:1881 PALM BAY RD NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2978
Practice Address - Country:US
Practice Address - Phone:321-951-2989
Practice Address - Fax:321-951-2998
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility