1164666962 NPI number — MRS. CLARISSA ISABELLE GILES PA-C

Table of content: MRS. CLARISSA ISABELLE GILES PA-C (NPI 1164666962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164666962 NPI number — MRS. CLARISSA ISABELLE GILES PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILES
Provider First Name:
CLARISSA
Provider Middle Name:
ISABELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAMIREZ
Provider Other First Name:
CLARISSA
Provider Other Middle Name:
ISABELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164666962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 NW 133RD TER
Provider Second Line Business Mailing Address:
APT 307
Provider Business Mailing Address City Name:
DAVIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33325-7684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-793-9301
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5353 W ATLANTIC AVE
Provider Second Line Business Practice Location Address:
SUITE 400-A
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33484-8174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-638-0598
Provider Business Practice Location Address Fax Number:
561-381-4581
Provider Enumeration Date:
04/23/2009

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: 363AS0400X , with the licence number:  PA9104959 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA9104959 , 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)





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