Individual
JACQUELINE ANGELES PORTOBANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18713 NW 46TH AVE, MIAMI GARDENS, FL 33055-2655
(754) 610-0209
Mailing address
18713 NW 46TH AVE, MIAMI GARDENS, FL 33055-2655
(754) 610-0209
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA16049
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTA16049
PERMINENT LICENSURE
FL
Enumeration date
11/01/2019
Last updated
11/01/2019
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