1235369182 NPI number — CHOICES HEALTH CENTER, INC.

Table of content: YVETTE CLARK MOLETA FNP (NPI 1851948590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235369182 NPI number — CHOICES HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOICES HEALTH CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1235369182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
747 FAWN RIDGE DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ORANGE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32763-8268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-456-1047
Provider Business Mailing Address Fax Number:
866-707-3476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
747 FAWN RIDGE DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763-8268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-456-1047
Provider Business Practice Location Address Fax Number:
866-707-3476
Provider Enumeration Date:
07/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
SHANE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
386-456-1047

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  HCC7157 , 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: 004619500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com