Healthcare Provider Details

I. General information

NPI: 1699339861
Provider Name (Legal Business Name): MARIA VICTORIA SANTOS CALIZ PTA, AT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 AVE CONSTANCIA URB VILLA DEL CARMEN
PONCE PR
00716-2233
US

IV. Provider business mailing address

4465 AVE CONSTANCIA URB VILLA DEL CARMEN
PONCE PR
00716-2233
US

V. Phone/Fax

Practice location:
  • Phone: 787-438-4369
  • Fax:
Mailing address:
  • Phone: 787-438-4369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2056
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: