Provider Demographics
NPI:1902507171
Name:AURELUS, KIKE ITOHAN
Entity Type:Individual
Prefix:
First Name:KIKE
Middle Name:ITOHAN
Last Name:AURELUS
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 1:16338 SAINT AUGUSTINE ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-4994
Mailing Address - Country:US
Mailing Address - Phone:407-401-0257
Mailing Address - Fax:
Practice Address - Street 1:16338 SAINT AUGUSTINE ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-4994
Practice Address - Country:US
Practice Address - Phone:407-401-0257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN110249582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry