Provider Demographics
NPI:1841483393
Name:MARGARITA CORREA LLC
Entity type:Organization
Organization Name:MARGARITA CORREA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA-PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-404-6959
Mailing Address - Street 1:720 ALMOND ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3124
Mailing Address - Country:US
Mailing Address - Phone:352-404-6959
Mailing Address - Fax:352-404-6960
Practice Address - Street 1:720 ALMOND ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3124
Practice Address - Country:US
Practice Address - Phone:352-404-6959
Practice Address - Fax:352-404-6960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME898442081P0010X, 208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002064300Medicaid