Provider Demographics
NPI:1871299602
Name:GUNDERSEN, CLAUDIA ESTELA
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:ESTELA
Last Name:GUNDERSEN
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 1:5503 PINE ISLAND RD NW
Mailing Address - Street 2:
Mailing Address - City:BOKEELIA
Mailing Address - State:FL
Mailing Address - Zip Code:33922-3211
Mailing Address - Country:US
Mailing Address - Phone:407-367-8765
Mailing Address - Fax:
Practice Address - Street 1:5503 PINE ISLAND RD NW
Practice Address - Street 2:
Practice Address - City:BOKEELIA
Practice Address - State:FL
Practice Address - Zip Code:33922-3211
Practice Address - Country:US
Practice Address - Phone:407-367-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL75017225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist