Provider Demographics
NPI:1598465080
Name:FLORIAL, JULEM
Entity Type:Individual
Prefix:
First Name:JULEM
Middle Name:
Last Name:FLORIAL
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 1:632 WEKIVA CREST DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-1475
Mailing Address - Country:US
Mailing Address - Phone:321-541-3127
Mailing Address - Fax:
Practice Address - Street 1:632 WEKIVA CREST DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-1475
Practice Address - Country:US
Practice Address - Phone:321-541-3127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172A00000X
172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver