1033452578 NPI number — SABRINA MARIE SEUS D.O.

Table of content: SABRINA MARIE SEUS D.O. (NPI 1033452578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033452578 NPI number — SABRINA MARIE SEUS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEUS
Provider First Name:
SABRINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033452578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2496 HARBOUR COVE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUTCHINSON ISLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34949-1561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-483-5985
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 SOUTH 23RD STREET
Provider Second Line Business Practice Location Address:
LAWNWOOD REGIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
FORT PIERCE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-467-8291
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  OS14027 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 113191700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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