Healthcare Provider Details

I. General information

NPI: 1588905764
Provider Name (Legal Business Name): MARIA VAN SANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 DOVE DR
ORLANDO FL
32803-3021
US

IV. Provider business mailing address

1110 DOVE DR
ORLANDO FL
32803-3021
US

V. Phone/Fax

Practice location:
  • Phone: 407-970-2940
  • Fax: 407-896-9970
Mailing address:
  • Phone: 407-970-2940
  • Fax: 407-896-9970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA6324
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberSA6324
License Number StateFL

VIII. Authorized Official

Name: MRS. MARIA G VAN SANT
Title or Position: OWNER
Credential: SLP
Phone: 407-970-2940