Provider Demographics
NPI:1821395849
Name:PETIT-RAYMOND, MARITHA
Entity Type:Individual
Prefix:
First Name:MARITHA
Middle Name:
Last Name:PETIT-RAYMOND
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 1:7011 NW 25TH CT
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2046
Mailing Address - Country:US
Mailing Address - Phone:954-638-1589
Mailing Address - Fax:
Practice Address - Street 1:12401 ORANGE DR
Practice Address - Street 2:SUITE219
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4341
Practice Address - Country:US
Practice Address - Phone:954-862-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant