Healthcare Provider Details

I. General information

NPI: 1003661653
Provider Name (Legal Business Name): MARIA DE LOS ANGELES PUPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BONNIE BLVD APT 107
PALM SPRINGS FL
33461-1317
US

IV. Provider business mailing address

201 BONNIE BLVD APT 107
PALM SPRINGS FL
33461-1317
US

V. Phone/Fax

Practice location:
  • Phone: 561-601-4641
  • Fax:
Mailing address:
  • Phone: 561-601-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-336470
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: