1144402538 NPI number — DR. JOSENIE DESAMOUR INTERNAL MEDICINE

Table of content: LIZ ROCIO ALMEIDA (NPI 1104601442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144402538 NPI number — DR. JOSENIE DESAMOUR INTERNAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESAMOUR
Provider First Name:
JOSENIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
INTERNAL MEDICINE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DESAMOUR
Provider Other First Name:
JOSENIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144402538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
441 NW 188TH TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33029-3297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-319-1521
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 HIGHWAY 44 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INVERNESS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34453-3722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-556-6881
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2007

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:  ME115161 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008814900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".