Healthcare Provider Details

I. General information

NPI: 1841483393
Provider Name (Legal Business Name): MARGARITA CORREA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ALMOND ST
CLERMONT FL
34711-3124
US

IV. Provider business mailing address

720 ALMOND ST
CLERMONT FL
34711-3124
US

V. Phone/Fax

Practice location:
  • Phone: 352-404-6959
  • Fax: 352-404-6960
Mailing address:
  • Phone: 352-404-6959
  • Fax: 352-404-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberME89844
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME89844
License Number StateFL

VIII. Authorized Official

Name: MARGARITA CORREA-PEREZ
Title or Position: PRESIDENT
Credential: MD
Phone: 352-404-6959