Provider Demographics
NPI:1205517091
Name:DOS SANTOS POVEDA, AGNES (MA)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:DOS SANTOS POVEDA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 MAITLAND AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6840
Mailing Address - Country:US
Mailing Address - Phone:407-767-2000
Mailing Address - Fax:407-260-1619
Practice Address - Street 1:609 MAITLAND AVE STE 4
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6840
Practice Address - Country:US
Practice Address - Phone:407-767-2000
Practice Address - Fax:407-260-1619
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA99930225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist