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General NPI Number Information
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NPI Number | 1306204839
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Entity Type | Individual
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Provider Name | AVE GAY PANGANIBAN
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Gender | Female
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 333 E ONTARIO ST UNIT 801
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City | CHICAGO
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State | IL
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Zip | 60611-4804
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Country | US
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Telephone | 305-934-6122
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Fax |
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Provider Business Mailing Address
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Address Line | 15874 NE 10TH CT
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-5350
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Country | US
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Telephone | 305-934-6122
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056011362
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT16470
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License Number State | FL
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