Provider Demographics
NPI:1740064971
Name:KURUVILLA, REENA
Entity type:Individual
Prefix:
First Name:REENA
Middle Name:
Last Name:KURUVILLA
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 1:402 APACHE LN
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4746
Mailing Address - Country:US
Mailing Address - Phone:813-728-1686
Mailing Address - Fax:
Practice Address - Street 1:402 APACHE LN
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4746
Practice Address - Country:US
Practice Address - Phone:813-728-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTN42430156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist