1134781685 NPI number — DR. KALENE CAMILLE SETRIN AUD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134781685 NPI number — DR. KALENE CAMILLE SETRIN AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SETRIN
Provider First Name:
KALENE
Provider Middle Name:
CAMILLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUTMAN
Provider Other First Name:
KALENE
Provider Other Middle Name:
CAMILLE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134781685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 CLINT MOORE RD STE 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33487-5716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-939-0177
Provider Business Mailing Address Fax Number:
561-338-6271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3006 W AZEELE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33609-3139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-879-8045
Provider Business Practice Location Address Fax Number:
813-450-2461
Provider Enumeration Date:
07/05/2019

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: 231H00000X , with the licence number:  AY2430 , 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: Y9G5Y . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 115324700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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