1588905764 NPI number — MARIA VAN SANT LLC

Table of content: (NPI 1588905764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588905764 NPI number — MARIA VAN SANT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIA VAN SANT LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588905764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 DOVE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32803-3021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-970-2940
Provider Business Mailing Address Fax Number:
407-896-9970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 DOVE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-970-2940
Provider Business Practice Location Address Fax Number:
407-896-9970
Provider Enumeration Date:
03/12/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VAN SANT
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-970-2940

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA6324 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: SA6324 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1396879938 . This is a "NPI PERSONAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 891736100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004451200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".