1548210180 NPI number — DELOS CLIFT MD PA

Table of content: (NPI 1548210180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548210180 NPI number — DELOS CLIFT MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELOS CLIFT MD PA
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:
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:
1548210180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 N ORANGE AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32804-7613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-472-0840
Provider Business Mailing Address Fax Number:
407-472-0841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 N ORANGE AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32804-7613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-472-0840
Provider Business Practice Location Address Fax Number:
407-472-0841
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENITEZ
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
407-472-0840

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  ME60789 , 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: 2068831 . This is a "AETNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2380840009 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 12931 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: A004 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 211537 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com