Provider Demographics
NPI:1780454777
Name:PORTNOY, ANGELA VICTORIA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:VICTORIA
Last Name:PORTNOY
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 1:9051 KINGSMOOR WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5668
Mailing Address - Country:US
Mailing Address - Phone:610-800-2010
Mailing Address - Fax:
Practice Address - Street 1:1803 S AUSTRALIAN AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6454
Practice Address - Country:US
Practice Address - Phone:610-800-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor