Provider Demographics
NPI:1790041341
Name:FIGUEROA, ELIOMAR (COTA/L)
Entity Type:Individual
Prefix:
First Name:ELIOMAR
Middle Name:
Last Name:FIGUEROA
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 LITTLE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9649
Mailing Address - Country:US
Mailing Address - Phone:407-922-1291
Mailing Address - Fax:
Practice Address - Street 1:5151 LITTLE LN
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-9649
Practice Address - Country:US
Practice Address - Phone:407-922-1291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11082314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility