Provider Demographics
NPI:1497295570
Name:VICTORIA KNOPP, INC.
Entity Type:Organization
Organization Name:VICTORIA KNOPP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGO KNOPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-427-8409
Mailing Address - Street 1:11701 150TH CT N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-3518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:561-744-3523
Practice Address - Street 1:11701 150TH CT N
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33478-3518
Practice Address - Country:US
Practice Address - Phone:561-427-8409
Practice Address - Fax:561-744-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3489252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8106720Medicaid