1689992893 NPI number — DR. MARIVETTE MACHADO CORTES MD

Table of content: DR. MARIVETTE MACHADO CORTES MD (NPI 1689992893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689992893 NPI number — DR. MARIVETTE MACHADO CORTES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACHADO CORTES
Provider First Name:
MARIVETTE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1689992893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2995 DREW STREET FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33759-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-532-1355
Provider Business Mailing Address Fax Number:
813-635-2613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 PINELLAS STREET SUITE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33756-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-461-8300
Provider Business Practice Location Address Fax Number:
813-635-2187
Provider Enumeration Date:
05/12/2010

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:  ME122927 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: ME122927 , 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: 022552200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".