Provider Demographics
NPI:1740742766
Name:PUELLO, PERSIS CELINA (MD)
Entity Type:Individual
Prefix:
First Name:PERSIS
Middle Name:CELINA
Last Name:PUELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PERSIS
Other - Middle Name:CELINA
Other - Last Name:FLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 N FRANKLIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5831
Mailing Address - Country:US
Mailing Address - Phone:813-229-2225
Mailing Address - Fax:
Practice Address - Street 1:101 N FRANKLIN ST STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5831
Practice Address - Country:US
Practice Address - Phone:813-229-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME155116207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine