Provider Demographics
NPI:1184215311
Name:PUBAL, ANNIE MARIA (AUD)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:MARIA
Last Name:PUBAL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NW 13TH ST 206
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2858
Mailing Address - Country:US
Mailing Address - Phone:561-391-3333
Mailing Address - Fax:561-391-5618
Practice Address - Street 1:27406 CASHFORD CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544
Practice Address - Country:US
Practice Address - Phone:813-994-8900
Practice Address - Fax:813-793-7386
Is Sole Proprietor?:No
Enumeration Date:2021-01-31
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2424231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist