Provider Demographics
NPI:1851891824
Name:NAVIDAD, MARIA PAMELA SAMONTE
Entity Type:Individual
Prefix:
First Name:MARIA PAMELA
Middle Name:SAMONTE
Last Name:NAVIDAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 LAKE LYNDA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1481
Mailing Address - Country:US
Mailing Address - Phone:800-774-7785
Mailing Address - Fax:888-300-5136
Practice Address - Street 1:307 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ROBERT LEE
Practice Address - State:TX
Practice Address - Zip Code:76945-5067
Practice Address - Country:US
Practice Address - Phone:325-453-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1288381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist