Provider Demographics
NPI:1235336306
Name:LAMOUTTE & VERDEJA MDS P A
Entity Type:Organization
Organization Name:LAMOUTTE & VERDEJA MDS P A
Other - Org Name:WOMEN FIRST CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMOUTTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-719-3380
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33564-1090
Mailing Address - Country:US
Mailing Address - Phone:813-719-3380
Mailing Address - Fax:813-719-3060
Practice Address - Street 1:1601 W TIMBERLANE DR
Practice Address - Street 2:SUITE 600
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-0959
Practice Address - Country:US
Practice Address - Phone:813-719-3380
Practice Address - Fax:813-719-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-01
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 78183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45523OtherBCBS
FL45523OtherBCBS