1407666357 NPI number — ALINE MICHELE LEUTZ DA SILVA GODINHO PT

Table of content: ALINE MICHELE LEUTZ DA SILVA GODINHO PT (NPI 1407666357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407666357 NPI number — ALINE MICHELE LEUTZ DA SILVA GODINHO PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEUTZ DA SILVA GODINHO
Provider First Name:
ALINE MICHELE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1407666357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5689 NEW INDEPENDENCE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER GARDEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-244-0547
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 SPRING CENTRE S. BLVD
Provider Second Line Business Practice Location Address:
STE 225
Provider Business Practice Location Address City Name:
ALTMONTE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-495-1165
Provider Business Practice Location Address Fax Number:
800-688-2049
Provider Enumeration Date:
01/13/2025

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: 225100000X , with the licence number:  PT42627 , 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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