Provider Demographics
NPI:1952180838
Name:PURON, LIUDMILA
Entity Type:Individual
Prefix:
First Name:LIUDMILA
Middle Name:
Last Name:PURON
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 1:4520 DAVIS CT
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-9534
Mailing Address - Country:US
Mailing Address - Phone:305-725-8012
Mailing Address - Fax:
Practice Address - Street 1:4520 DAVIS CT
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-9534
Practice Address - Country:US
Practice Address - Phone:305-725-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician