1144912544 NPI number — MAGDALENA M DOLBRUS-GREENE

Table of content: MAGDALENA M DOLBRUS-GREENE (NPI 1144912544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144912544 NPI number — MAGDALENA M DOLBRUS-GREENE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOLBRUS-GREENE
Provider First Name:
MAGDALENA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1144912544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32849 NATURAL BRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESLEY CHAPEL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33543-7213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-706-1927
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37810 STATE ROAD 54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZEPHYRHILLS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33542-5428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-706-1927
Provider Business Practice Location Address Fax Number:
877-230-5629
Provider Enumeration Date:
05/23/2023

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: 251E00000X , with the licence number:  106060700 , 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: 106060700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com