Provider Demographics
NPI:1720484637
Name:POMALES, MARITZA SANTANA
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:SANTANA
Last Name:POMALES
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 1:3128 BLAINE CIR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-5335
Mailing Address - Country:US
Mailing Address - Phone:386-456-7841
Mailing Address - Fax:
Practice Address - Street 1:3128 BLAINE CIR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-5335
Practice Address - Country:US
Practice Address - Phone:386-456-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW9162104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker