1336349935 NPI number — DR. SOLANGE MOYA BURNETTE M.D.

Table of content: DR. SOLANGE MOYA BURNETTE M.D. (NPI 1336349935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336349935 NPI number — DR. SOLANGE MOYA BURNETTE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNETTE
Provider First Name:
SOLANGE
Provider Middle Name:
MOYA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOYA
Provider Other First Name:
SOLANGE
Provider Other Middle Name:
PITARELLO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336349935
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40767
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32203-0767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-376-3707
Provider Business Mailing Address Fax Number:
904-391-5001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-396-0000
Provider Business Practice Location Address Fax Number:
904-396-5206
Provider Enumeration Date:
07/20/2007

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: 207Q00000X , with the licence number:  ME116481 , 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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