| Doctor Name: | SELENNE RUBI GARNELO |
| NPI Number: | 1083026835 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | DO 5580 |
| Business Practice Address: | 7400 Gall Blvd Zephyrhills, FL - 335414371 |
| Business Phone Number: | 8137824546 |
| Business Fax Number: | 8137821902 |
| Mailing Address: | 4399 35th St N, ST PETERSBURG |
| State: | FL |
| Postal Code: | 337143722 |
| Phone Number: | 7275260501 |
| Fax Number: | 7275221408 |
| NPI Enumeration Date: | 05/28/2014 |
| NPI Last Update Date: | 05/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | DO 5580 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ZZ |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |