Healthcare Provider Details

I. General information

NPI: 1679812788
Provider Name (Legal Business Name): MARCELLE L FORTE GUILLAUME PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 41ST ST #200
MIAMI BEACH FL
33140-3516
US

IV. Provider business mailing address

PO BOX 402808
MIAMI BEACH FL
33140-0808
US

V. Phone/Fax

Practice location:
  • Phone: 305-695-0644
  • Fax: 305-532-1612
Mailing address:
  • Phone: 305-695-0644
  • Fax: 305-532-1612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9105642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: