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General NPI Number Information
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NPI Number | 1144426040
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Entity Type | Organization
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Legal Business Name | THERESA FORTALEZA-DAWSON MD PA
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 01/24/2013
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Provider Practice Location Address
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Address Line | 2006 NE 49TH ST
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-4524
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Country | US
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Telephone | 954-938-8998
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Fax | 954-938-8984
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Provider Business Mailing Address
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Address Line | 6278 N FEDERAL HWY SUITE 183
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-1916
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Country | US
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Telephone | 954-938-8998
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Fax | 954-938-8984
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Authorized Official
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Title or Position | OWNER
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Name | DR. THERESA FORTALEZA-DAWSON
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Credential | M.D.
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Telephone | 954-938-8998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME81298
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License Number State | FL
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