Provider Demographics
NPI:1891860771
Name:NATIVITY MEDICAL CENTER
Entity Type:Organization
Organization Name:NATIVITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-689-0904
Mailing Address - Street 1:2931 STATE ROAD 60 E
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-3416
Mailing Address - Country:US
Mailing Address - Phone:813-689-0904
Mailing Address - Fax:813-689-7549
Practice Address - Street 1:2931 STATE ROAD 60 E
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-3416
Practice Address - Country:US
Practice Address - Phone:813-689-0904
Practice Address - Fax:813-689-7549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0600474Medicaid
FL99197Medicare ID - Type Unspecified