Provider Demographics
NPI:1659682623
Name:DAGROSA, ANGELA (AYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:DAGROSA
Suffix:
Gender:F
Credentials:AYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 JUPITER LAKES BLVD
Mailing Address - Street 2:SUITE 2322D
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7102
Mailing Address - Country:US
Mailing Address - Phone:561-301-6442
Mailing Address - Fax:
Practice Address - Street 1:326 JUPITER LAKES BLVD
Practice Address - Street 2:SUITE 2322D
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7102
Practice Address - Country:US
Practice Address - Phone:561-743-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA33895225700000X
246ZG1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZG1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGeneticist, Medical (PhD)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist