Provider Demographics
NPI:1508639303
Name:SANTOS, PAMELA DE LOS ANGELES (BACB981845)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DE LOS ANGELES
Last Name:SANTOS
Suffix:
Gender:F
Credentials:BACB981845
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6943 ALOMA AVE APT 79
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7703
Mailing Address - Country:US
Mailing Address - Phone:321-444-9688
Mailing Address - Fax:
Practice Address - Street 1:6943 ALOMA AVE APT 79
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7703
Practice Address - Country:US
Practice Address - Phone:321-444-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-305887106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician