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General NPI Number Information
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NPI Number | 1457178071
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Entity Type | Individual
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Provider Name | GEORGE MARCEL DORTA CHAPIN PA
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Gender | Male
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Dates
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Enumeration Date | 09/24/2024
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 1539 DALE MABRY HWY STE 102
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City | LUTZ
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State | FL
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Zip | 33548-3008
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Country | US
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Telephone | 813-909-7102
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Fax | 813-909-0199
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Provider Business Mailing Address
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Address Line | 10618 DEERBERRY DR
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City | LAND O LAKES
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State | FL
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Zip | 34638-6890
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Country | US
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Telephone | 813-453-5023
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PACN69
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2307-P.A.
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License Number State | PR
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