Provider Demographics
NPI:1891241048
Name:MARSAN HEALTH CARE CLINIC INC
Entity type:Organization
Organization Name:MARSAN HEALTH CARE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA-FELIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-223-6915
Mailing Address - Street 1:4693 OLD PLEASANT HILL
Mailing Address - Street 2:SUITE A
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759
Mailing Address - Country:US
Mailing Address - Phone:407-223-6915
Mailing Address - Fax:407-223-6915
Practice Address - Street 1:4693 OLD PLEASANT HILL ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759
Practice Address - Country:US
Practice Address - Phone:407-223-6915
Practice Address - Fax:407-223-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN398208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88118Medicare PIN