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:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2504
Mailing Address - Country:US
Mailing Address - Phone:502-889-8200
Mailing Address - Fax:
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:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91339207PP0204X
KY38856208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6409176200Medicaid
FL6409176200Medicaid