Provider Demographics
NPI:1881678290
Name:FORTU, JESUSA MILALAINE TERRADO (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUSA MILALAINE
Middle Name:TERRADO
Last Name:FORTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 W STATE ROAD 84
Mailing Address - Street 2:#107
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-8827
Mailing Address - Country:US
Mailing Address - Phone:954-530-2660
Mailing Address - Fax:954-530-2660
Practice Address - Street 1:1000 JOE DIMAGGIO DR
Practice Address - Street 2:PEDIATRIC EMERGENCY DEPARTMENT
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5426
Practice Address - Country:US
Practice Address - Phone:954-987-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38856208000000X
FLME91339207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6409176200Medicaid
FL6409176200Medicaid