Provider Demographics
NPI:1790808293
Name:MARISSA ESTIVA MAGSINO MD PA
Entity Type:Organization
Organization Name:MARISSA ESTIVA MAGSINO MD PA
Other - Org Name:METROWEST INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:ESTIVA
Authorized Official - Last Name:MAGSINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-292-6778
Mailing Address - Street 1:PO BOX 2965
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-2965
Mailing Address - Country:US
Mailing Address - Phone:407-292-6778
Mailing Address - Fax:407-292-5297
Practice Address - Street 1:1507 S HIAWASSEE RD STE 115
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5706
Practice Address - Country:US
Practice Address - Phone:407-292-6778
Practice Address - Fax:407-292-5297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7670Medicare ID - Type Unspecified