Provider Demographics
NPI:1366413544
Name:MARISSA ESTIVA-MAGSINO MDPA
Entity type:Organization
Organization Name:MARISSA ESTIVA-MAGSINO MDPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:ESTIVA
Authorized Official - Last Name:MAGSINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-292-6778
Mailing Address - Street 1:PO BOX 2965
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-2965
Mailing Address - Country:US
Mailing Address - Phone:407-292-6778
Mailing Address - Fax:
Practice Address - Street 1:1507 S HIAWASSEE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5706
Practice Address - Country:US
Practice Address - Phone:407-292-6778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7670OtherMEDICARE GROUP NUMBER
21074WMedicare PIN
FLK7670OtherMEDICARE GROUP NUMBER