Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 4142 | FL |
NPI | 1073544318 |
---|---|
Provider Name | Dr. Maria R. Sangillo |
First Address | Pensacola, FL 32504-7218 |
Second Address | Pensacola, FL 32504-7218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 12/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
59-3460844 | TAX ID (01) | FL |
69967 | (02) | FL |