Healthcare Provider Details

I. General information

NPI: 1346864550
Provider Name (Legal Business Name): MARIANE TOMIYOSHI ASATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST STE 125
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

601 E ROLLINS ST STE 125
ORLANDO FL
32803-1248
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5815
  • Fax:
Mailing address:
  • Phone: 407-303-5815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351046853
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberME163670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: