1437574761 NPI number — NATALIA ANDREA MORSE DDS

Table of content: NATALIA ANDREA MORSE DDS (NPI 1437574761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437574761 NPI number — NATALIA ANDREA MORSE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORSE
Provider First Name:
NATALIA
Provider Middle Name:
ANDREA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIAZ SUAREZ
Provider Other First Name:
NATALIA
Provider Other Middle Name:
ANDREA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437574761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1137
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32902-1137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-952-9696
Provider Business Mailing Address Fax Number:
321-952-7937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 SARNO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32935-3084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-241-6800
Provider Business Practice Location Address Fax Number:
321-241-6888
Provider Enumeration Date:
02/24/2014

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: 1223G0001X , with the licence number:  4048 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DN20867 , 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: 014283100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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