Provider Demographics
NPI:1770711939
Name:HENDERSON, FLORITA CEZARINA (MD)
Entity type:Individual
Prefix:
First Name:FLORITA
Middle Name:CEZARINA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FLORITA
Other - Middle Name:CEZARINA
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:641-683-0800
Mailing Address - Fax:641-683-0801
Practice Address - Street 1:522 N HANCOCK ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-4231
Practice Address - Country:US
Practice Address - Phone:641-683-0800
Practice Address - Fax:641-683-0801
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-39689207R00000X
IA39689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP01104140OtherRR MEDICARE
IA1770711939Medicaid
IA719260528Medicare PIN