Provider Demographics
NPI:1689389587
Name:DESMARATTES, DAPHNE OF
Entity Type:Individual
Prefix:MISS
First Name:DAPHNE
Middle Name:OF
Last Name:DESMARATTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 SW 159TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2342
Mailing Address - Country:US
Mailing Address - Phone:305-962-8854
Mailing Address - Fax:
Practice Address - Street 1:767 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4000
Practice Address - Country:US
Practice Address - Phone:305-962-8854
Practice Address - Fax:954-372-1335
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory